Mad River & NKP Railroad Society, Inc
MEMBERSHIP APPLICATION

Name:___________________________________________________________________

Address:_________________________________________________________________

City:__________________________________State:___________ZIP:____________

Telephone :( ____)_________________

Memberships due April 1st for 1 year to March 31st .

Membership #:________________________

Check appropriate spaces you are or wish to be and enclose remittance.

__New Member    __Renewal   __ Change of Information   __ Reinstate

ONE YEAR MEMBERSHIPLIFE MEMBERSHIP
__Age 0 - 60 - $25.00 __Life Member - $500.00
__Age over 60 - $20.00
__Family - $35.00 (parent/s & children under 18)
__Sustaining - $80.00

$ __________Membership Dues

$ __________Extra Donations

$ __________Total Enclosed *

*All payments in US Funds **Please inquire about additional fees for postage outside continental United States.

Check items below that may interest you as a volunteer.
__Rolling Stock __Cleaning Buildings or Grounds
__Museum Attendant __Model Railroading
__Gift Shop Salesperson __Building Maintenance
__Mailing - Trips/Brochures __Newsletter Articles
__Landscaping __Displays
__Museum Tour Guides __Committee Work
__Other________________________________________________________
_________________________________________________________
_________________________________________________________

Volunteers are always welcome and needed. Thank you.

Mail Membership Application To:

Mad River & NKP Railroad Society, Inc.

ATTN:Membership Committee

233 York Street

Bellevue, Ohio 44811-1377

Office Use Only

Date ________________

$ _______________

Check # _____________

Cash _______________

Pd to Yr _____________

Treas _________________

Compr ________________

Secy __________________