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NRHS Gift At-Large/Student Membership FAX/Mail-in Form
    ____ Please tell me more about the NRHS and about nearby Chapters I can join.
    ____ Also please send me a sample copy of the NATIONAL RAILWAY BULLETIN. I'm enclosing $1.00 for postage.
    ____ Enroll the following individual as an At-Large Member for one year. I'm enclosing US
    $37.00.*
      ____ Also enroll the listed family member(s)/spouse as an associate for an Additional $5.00.
    ____ Enroll the following individual as a Student Member (under 13 - 18 years of age) for one year. I'm enclosing US $16.00.* Please indicate the Student's age: _____
      ____ Also enroll the listed family member(s)/spouse as an associate for an Additional $5.00.
    ____ Enroll the following individual as a Youth Member (under 5 - 13 years of age) for one year. I'm enclosing US $5.00.* Please indicate the Student's age: _____
      ____ Also enroll the listed family member(s)/spouse as an associate for an Additional $5.00.

    Please tell us about the person receiving this gift:

    First Name: ________________________________________________
    Middle Name: ________________________________________________
    Last Name: ________________________________________________
    Address 1: ________________________________________________
    Address 2: ________________________________________________
    City: ________________________________________________
    State/Province: ________________________________________________
    Zip/Postal Code: ________________________________________________
    Country: ________________________________________________
    Phone Number: ________________________________________________
    For the gift membership, we create a gift notification letter. Please
    *tell us where to send the notification: to me Directly to the recipient of my gift.
    Reason for Gift: ________________________________________________
    check this box if you would like us to include in the letter information on local NRHS Chapters in his/her area.
    Please tell us about yourself:
    First Name: ________________________________________________
    Middle Name: ________________________________________________
    Last Name: ________________________________________________
    Address 1: ________________________________________________
    Address 2: ________________________________________________
    City: ________________________________________________
    State/Province: ________________________________________________
    Zip/Postal Code: ________________________________________________
    Country: ________________________________________________
    Phone Number: ________________________________________________
    Email Address: ________________________________________________

    Payment Method

    Check/Money Order payable to "National Railway Historical Society"
    Charge my Visa
    Charge my Mastercard
    Charge my American Express

      Card Number:
      Expiration Date: Month:     Year:

      Name As It Appears On Card: _______________________________________


      Signature of Card Holder: __________________________________________

    MAIL ALONG WITH PAYMENT TO:

    NRHS Membership
    Fernley & Fernley, Inc.
    100 North 20th Street, Suite 400
    Philadelphia, PA 19103-1443

    FAX TO:
    (215) 557-6740

      (Please Print Or Type).

NOTE: NRHS Memberships expire on Dec. 31. New memberships that start after September 1st include the rest of the year and all of the next year at this year's regular membership price.
Click for Information about the NRHS Service Mark