Please provide the following contact information: (* denotes required fields)

First Name	*
Last Name	*
2nd Party Name	(* if Dual Membership)
Company
Address	*
City	*
State	Zip *
Work Phone	*
Home Phone
FAX
E-mail	*
Website URL
New Membership   Renewal
Membership Rates (Annual Rate from Jan 1 - Dec 31):*
Single Annual Membership ($25.00)
Dual Annual Membership ($35.00)
Company Annual Membership ($50.00)
Patron Annual Membership ($100.00)
New annual member applications made after July 1 are billed at half price.
Single Life Membership one time payment ($400.00)
Dual/Co. Life Membership one time payment ($500.00)
Total Amount Remitted $*
Add my website listed on the Links page
Omit my telephone number in the membership directory
Omit my address in the membership directory

After you have completed this form, click SUBMIT FORM below to send a confirming email,
and then print out the Confirmation page. 
 

Include this Confirmation page with your check and send via U.S. Mail to:
     Cowan Pottery Museum Associates, PO Box 16765, Rocky River, OH 44116