Museum Pass Form

Senator Dave Syverson's Museum Pass Card provides FREE entry for up to four people for one day at several Chicagoland area museums and zoos. A minimum of 3 business days’ notice is required to reserve the pass. The pass can be used at the following locations:

Adler Planetarium
The Art Institute of Chicago
Brookfield Zoo
Chicago Botanic Garden
Chicago Children's Museum
Chicago History Museum
Dusable Museum of African American History
The Field Museum
Illinois Holocaust Museum & Education Center
Lincoln Park Zoo
Museum of Contemporary Art
Museum of Science and Industry
National Museum of Mexican Art
National Museum of Puerto Rican Arts & Culture
Peggy Notebaert Nature Museum
John G. Shedd Aquarium

Point of Contact Name (First and Last):*

Home Address*

Street 1 Street 2 City State Zip

Cell Phone* () -

Email Address*

Date of Requested Museum Visit (Format: MM-DD-YYYY)*

Names of Individuals gaining entry on the pass (up to four total, please provide first and last names):*

Museum or Zoo that will be visited:*

Would you like to sign up to receive email updates from Senator Syverson?*

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