The Canadian Friends of the Hermitage

The Friends are the volunteer branch of The State Hermitage Museum Foundation of Canada, Inc. Official tax receipts (charitable registration no. 87879 9865 RR0001) will be issued for donations $5 or more above the basic membership fee (Contributing and higher levels use the $60 Individual level as their basic fee for tax purposes).

Membership Application Form

Please print this form, complete it, and mail it with your enclosed cheque or money order.

I wish to join The Canadian Friends of the Hermitage as (check your category):

__ Senior (60+) $45.00
__ Student (evidence of full-time student status is required) $30.00
__ Individual Friend $60.00
__ Family (includes 2 adults and 2 children) $75.00
__ Contributing Member $100.00
__ Sustaining Member $250.00
__ Patron $500.00
__ Ambassador's Circle $1,000.00 and over

Member's Name: ___________________________________________________________

Family Member's Names: ___________________________________________________

Address: _________________________________________________________________

Address: _________________________________________________________________

City: ______________________ Province: ___________ Postal Code:___________

Telephone: (___)_________ Other phone: (___)_________ Fax: (___)__________

E-mail addresses: ________________________________________________________

Prefered Language(s) (for English or French Newsletter): _________________

Chapter for local events (Toronto, Montreal or Ottawa/National): _________

Comments, volunteer work you'd like to do, etc: __________________________

__________________________________________________________________________

Method of payment: By cheque or money order. Cheques should be made out to "Canadian Friends of the Hermitage" except Corporate Friend and Founders' Circle levels should be to "The State Hermitage Musuem Foundation of Canada". Please mail to:

Canadian Friends of the Hermitage
National Office - Membership
280 Metcalfe Street, Suite 400
Ottawa, Ontario
Canada  K2P 1R7