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NRHS Membership Information Request 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 me as an At-Large Member for one year. I'm enclosing US $34.00.
      ____ Enroll my family member(s)/spouse as well for an Additional $5.00 per person.
    ____ Enroll me as Student Member for one year. I'm enclosing US $16.00.
      ____ Enroll my family member(s)/spouse as well for an Additional $5.00 per person.

    (Please Print Or Type).

    First Name: ________________________________________________
    Middle Name: ________________________________________________
    Last Name: ________________________________________________
    Address 1: ________________________________________________
    Address 2: ________________________________________________
    City: ________________________________________________
    State/Province: ________________________________________________
    Zip/Postal Code: ________________________________________________
    Country: ________________________________________________
    Phone Number: ________________________________________________
    Email Address: ________________________________________________
    Family Member Name (if joining): ________________________________________________


    Signature:
    (if joining)

    		 _________________________________________________
    Family Member Signature:
    (if joining)    		 _________________________________________________

    Payment Method

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


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