The Neill-Cochran House Museum
Friends Membership Form

Name ___________________________________________________
Address _________________________________________________
City ________________ State _____________ Zip ______________
Daytime phone _______________ Evening phone _______________
Email address ____________________________________________

GIFT
This membership is a gift for:

Name ____________________________________________________
Address __________________________________________________
City _________________________ State _________ Zip __________

Membership Categories
Please check one of the membership categories below
OR indicate your contribution here:
$____________________________

House Society....................$35
Hill Society.........................$50
Neill Society.......................$100
Cochran Society.................$500
Abner Cook Society............$1,000
Museum Society................$1,500
Founders Circle..................$2,000
Student Membership...........$20

Method of Payment
Please make checks payable to: The Neill-Cochran House Museum

My check is enclosed for $ _____________________

Please charge $ ____________________ to:

VISA
MasterCard
American Express
Discover

Card number _______________________ Expiration date ___/___

Signature ______________________________________________

The Neill-Cochran Museum House
2310 San Gabriel
Austin, Texas 78705-5014
512-478-2335