NHRHTA MEMBERSHIP APPLICATION FORM

Updated 16 October 2013


Please print out a copy of this page, complete the questions and send this form along with a check payable to "Treasurer, NHRHTA", to:

Richard Pedersen, NHRHTA Membership Chairman
49 Carnation Street
Bergenfield, NJ 07621
E-mail: nynhh@msn.com

Please print the following information:

Name (Last, First):___________________________________________________________________________________

Mailing Address:____________________________________________________________________________________

City:___________________________________________ State:____________________ Zip:______________________

Country:_________________________________ Telephone:____________________________ Date:________________

E-mail Address:_____________________________________________________________________________________

Are you a former NHRHTA member? [ ] Yes. [ ] No. Former member number:_____________

Membership category: United States resident – [ ] Regular ($35.00). [ ] Sustaining ($50.00).

Membership category: Canadian resident – [ ] Regular (US$40.00). [ ] Sustaining (US$50.00).

Membership category: Other Foreign resident – [ ] Regular (US$75.00). [ ] Sustaining (US$90.00).

By becoming a Sustaining Member, your donation helps the NHRHTA expand its production of magazines, books, videos and other New Haven Railroad related material. Please consider a Sustaining Membership. Thank you.

Canadian and foreign subscribers - please contact Rich Pedersen via mail or E-mail BEFORE sending any funds.  He has PAYMENT ALTERNATIVES that may save you currency conversion fees.

Please include a check for your membership category amount payable to "Treasurer, NHRHTA" and mail this completed form to:

Richard Pedersen, NHRHTA Membership Chairman
49 Carnation Street
Bergenfield, NJ 07621
E-mail: nynhh@msn.com