BRHS Membership Application

Please print this form on your printer and mail to address below.
Hint - Fill out the form on your computer, then print it.
  Please check ALL that applies to you.
Name
Address
City
State
ZIP
Phone Number
E-mail Address
We do not sell our membership roster, however we distribute
localized lists to members for various reasons. If you object to
having your name and address distributed please check this box.
 
Membership category:
Regular: One year $30
 (Entitled to one vote, all activities,and all publications during the year.)
Family: One year $30
 (Same as Regular plus all members of family may participate in contests)
Subscription: One year $30
 (For libraries, museums, societies, and other groups. Entitled to all publications but is not allowed to vote in business matters.)
Sustaining: One year - $60 or more*
 *amount above $30 is tax deductible
For mail outside of US add: Surcharge per year - $15.00
Total enclosed $
Roads of Interest
CB&Q
C&S
FW&D		 Narrow Gauge
Predecessor Road

Topics of Interest
Motive Power
Freight Cars
Passenger Cars
Waycars & other non-revenue cars
Structures
Operations
Technical Data
Drawings, Plans, etc.
Describe Yourself
Modeler
N HO S O G Other
Photographer
Prints Slides Movies/Video
Collector
China Paper Hardware Other
Historian
Burlington Route Veteran
Division
Department
Years Employed to
How you became aware of the BRHS
Web Page
Another Member of the BRHS
Application in retail shop copy of the Bulletin
Attended an annual or spring meet
Hobby Magazine
Other

Make check or money order (DO NOT SEND CASH!) payable to: BRHS then mail to:

Burlington Route Historical Society
Membership Services, Dept. I
P. O. Box 456
La Grange, IL 60525