Membership Application Form
Piedmont Railroad Museum & Library

Please complete this form on screen, then print with the button below and mail with your payment.


Name of applicant:

Address — Street

Address — Other

City, State, Zip+4 Code

E-mail Address:

Phone w/Area Code

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I would like to become a member

$40 Single

$60 Family

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Relive the adventure — contribute and help us enjoy the scenery from the

$100 Coach Car

$250 Diner Car

$500 Observation Car

$1,000 Executive Car

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Help build the station plaza. Buy a brick with your name on it.

$500

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I would like to advance the Piedmont Railroad Museum & Library project with an additional donation of:

$

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I would like to give a gift membership at the $ level to:

Name:

Address:

City, State, Zip+4 Code

E-mail Address:

Phone w/Area Code


My check or money order for $ is enclosed.


Mail completed applications (with payment made out to "PRM&L, Inc.") to:

Piedmont Railroad Museum & Library
206 Widecombe Court
Cary, NC 27613-4766


Payment must accompany registration form. Please DO NOT staple your check or money order to your registration form.


OFFICE USE ONLY:

Received:_____________ Check #:__________ Amount:____________ Registration No.: ___________


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