Aquarium for All Membership Application

Thank you for your interest in an Aquarium for All family membership!

An Aquarium for All membership is a $15 (plus tax) year-long membership for up to 2 adults & 4 youth that receive qualifying income-related assistance benefits. Additional adults & youth from the same family can be added for an additional $5 (plus tax) per person.

The Butterfly House & Aquarium (BHA) requires presentation of your membership card and ID for verification purposes prior to entry. The BHA also requires a minimum of a 1 adult to 5 youth ratio. Youth under the age of 16 MUST be accompanied by an adult.

This form is an application and not a guarantee of approval for an Aquarium for All membership. Memberships will be given as available funding allows.

ADULT #1 (INCLUDED)

First Name

Last Name

Address

City

State

Zip Code

Phone

ADULT #2 (INCLUDED)

First Name

Last Name

Phone

YOUTH #1 (INCLUDED)

First Name

Last Name

Age

YOUTH #2 (INCLUDED)

First Name

Last Name

Age

YOUTH #3 (INCLUDED)

First Name

Last Name

Age

YOUTH #4 (INCLUDED)

First Name

Last Name

Age

Additional Members (NOT INCLUDED)

NOTE: Each additional member added will cost $5 + tax each. Please list any additional family members you wish to add on your membership. Include their first name, last name, & age.

Are you a customer with Midco?

Yes

Answering “no” will not effect your eligibility to receive a membership.

What income-assistance do you receive?

You will be required to provide proof of benefit eligibility & photo ID prior to approval of your membership.

How did you hear about the Aquarium for All program?

Are there other circumstances that make access to the Butterfly House & Aquarium difficult for your family?

Upload Copy of Photo I.D.

Upload Copy of Proof of Benefits

By checking this box, I understand that I will not be approved without providing proof of benefit eligibility & a photo ID.

Digital Signature

By digitally signing below, I understand that by submitting this application, I am not guaranteed an Aquarium for All membership. Memberships will be given as available. I understand that I will be required to provide proof of benefits and a matching photo ID to qualify for Aquarium for All membership approval.

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