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

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

I would like to become a member

$45 Single

$60 Family

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

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

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

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

$500

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

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

$

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

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
P.O. Box 12551
Raleigh, NC 27605-2551


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.: ___________


  

Copyright © 2009 – 2012 Piedmont Railroad Museum & Library, Inc. All rights reserved. Last updated: Thursday November 1, 2012