American Airlines C.R. Smith Museum Membership Application

Yes! Enroll me as a Member of the American Airlines C.R. Smith Museum,
I have checked my membership choice below:

Annual - $50.00 Annual-Family - $75.00
Lifetime Gold - $250.00 Lifetime Flagship - $500.00 Lifetime Platinum $1,000.00

Membership dues are enclosed.  Amount $___________  
Please make checks payable to “The "C.R. SMith Aviation Foundation." Please do not send cash.
If you choose a LIFETIME membership and PAY IN FULL when you join, you will receive Silverbird: The Story of American Airlines by Don Bedwell.

OR

If you are an American Airlines or AMR employee and you would like to be a LIFETIME
member, you can fulfill your pledge via payroll deduction. Please indicate the appropriate amount.

Please check one:
___ Lifetime Gold - $250.00
___ $12.50 minimum per paycheck until pledge is reached. If you are a M1 payroll, deductions will be $25.00 per paycheck.

___ Lifetime Flagship - $500.00
___$25.00 minimum per paycheck until pledge is reached. If you are a M1 payroll, deductions will be $50.00 per paycheck.

___Lifetime Platinum - $1,000.00
___$25.00 minimum per paycheck until pledge is reached. If you are a M1 payroll, deductions will be $50.00 per paycheck.

____$_________ per paycheck until pledge is reached. If you prefer, you may donate a greater amount per paycheck to reach your pledge sooner. (Should you leave the company before you fulfil payment of lifetime membership dues you are then responsible to arrange with the museum payment of the balance owed.)

OR

____ VISA ____ MasterCard ____ American Express
__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ Account Number__ __ __ __Exp.Date

Signature_____________________________________________Date_______________

PLEASE COMPLETE THE FOLLOWING INFORMATION AND SIGN:

Name: Last__________________ First ________________________________
Address_________________________________________________________
City________________________State________Zip _____________________
E-mail _________________________________________________________
Employee # ____________ Active Emp (Y/N)______Sta/Bra Company Code Payroll Area _____
Company Code and Payroll Area appear in the upper left-hand corner of your paycheck stub.
Signature _____________________________Date______________________

Please complete this form and return to:
C.R. Smith Museum
PO Box 619617
GSWFA, MD808...........................................817-967-5915
DFW Airport, TX 75261-9617.................. 817-967-5737 Fax