Family Membership

Please select a 1-year or 2-year membership.

Is this a renewal?

Membership Number:

Title:

*First Name
*Last Name
Please Provide Details About the Secondary Card Holder :
Title of Secondary Membership Holder

*Full Name of Secondary Membership Holder:
Full Name of Child 1 (Up to 19 years of age):
Full Name of Child 2 (Up to 19 years of age):
Full Name of Child 3 (Up to 19 years of age):
Full Name of Child 4 (Up to 19 years of age):
*Please send correspondence in:

Please send me the National Gallery of Canada's Electronic Newsletter as well as Membership electronic updates:
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