Membership Form


INTRACOASTAL MODEL RAILROAD CLUB APPLICATION FORM

NAME: ____________________________________________________________________

ADDRESS: ___________________________________________________________________

CITY: ____________________________________________________________________

STATE: ___________ ZIP: ____________

HOME PHONE: ________ ________ ___________

CELL PHONE: ________ ________ ___________

SPOUSE’S NAME: ______________________

EMAIL: ______________________________________________


SCALES: G #1 O On30 S HO N Z


LAYOUT: YES ________ NO ____ PLANNED ____ NONE _____


MEMBERSHIP TYPE: Regular: $35 ___ Family: $40 ____ Associate: [age 18-21] $25 ____
Junior [age 12-18]: $15 ____ Initial one-time maintenance fee: $25 ____


How did you first hear about the Club?