The Railway & Locomotive Historical Society, Inc

2008 Membership Application/Renewal Form - International

MEMBERSHIP YEAR RUNS FROM JANUARY 1 THROUGH DECEMBER 31

All Railroad History publications will be mailed to you by USPS International Express Letter Mail in order to insure a more timely delivery of our books. Postage costs are included in the dues structure.

RAILWAY & LOCOMOTIVE HISTORICAL SOCIETY DUES (All members must pay these dues)

Please choose your level of membership and mark your selection on the list below.

___Regular ___Sustaining

$43.00 $93.00

___Family ___Patron

$48.00 $268.00

___Contributing

$68.00

Optional donation to R&LHS $_______

Enter the sum of your membership and optional donation here (Line 1) $_______

CHAPTERS: Chicago Golden Spike Ogden Lackawanna New York Pacific Coast Southeast Jacksonville Southwest El Paso Southern California

DUES     $14.00 $12.00 $25.00 $27.50 $20.00 $15.00 $12.00 $15.00

OPTIONAL DONATION ________ ________ ________ ________ ________ ________ ________ ________

TOTAL __________ __________ __________ __________ __________ __________ __________ __________

Add total amount in each chapter line you selected and enter the sum here                      (Line 2) $_______

Add the amounts on lines 1 and 2 above and enter the total in the box

$

Payment may be made by check (Payable to R&LHS) or credit card (Complete charge form below)

Mail this entire form (or a photocopy) and your check or credit card information to:

R&LHS Membership, PO Box 600544, Jacksonville FL 32260-0544

I do not want my address made available to any other agency.

HOW DID YOU LEARN ABOUT R&LHS? ____________________________________________________________

Your Name ______________________________Spouse’s Name_____________________

Mailing Address_____________________________________________________________

City_____________________________ Prov.____________ Postal Code_____________

Country____________________________email _________________________________

OFFICE USE ONLY: P ___ CS ___ DEP ____ Pmt By: CH ____ CC____ DATE REC’D______________

*CREDIT CARD YOU WISH TO USE VISA _____ OR        MASTER CARD ________

*NAME AS IT APPEARS ON CARD (PLEASE PRINT) _______________________________

*CARD NUMBER _________ _________ _________ _________ *EXP. DATE ____________

*SIGNATURE__________________________________________________________________

*ALL LINES MUST COMPLETED FOR YOUR CREDIT CARD CHARGE TO BE ACCEPTED

For office use only
NAT'L________	CH________	GS________	LAC________	NY________
PCC________	SoC________	SoE________	SoW________		TOTAL_________