Welcome to Burlington Route Historical Society
Membership Application

Become a BRHS Member Today
INSTRUCTIONS:
1.
Fill in sections 1, 2, 3,and optionally 4 and 5. Click on the Submit button.
2. On the next page review your entry information. Click on Confirm or return to make corrections.
3. On the third or Confirmation Page, depending upon your choice, choose either the On-Line payment option or the Print-n-mail in your check payment option.

* Required entry fields
First Name:   *
Middle Initial:  
Last Name:   *
Company:  
Address 1:   *
Address 2:  
City:   *
State/Provance: (USA and Canada only. Enter others below.)
States other then in
the USA or Canada:
ZIP/Postal Code:  
Country:   USA       Other    (If 'Other' please enter country name below.)
Other Country:  
( A postage fee of $20 is applied to all destinations other then the USA.)

House Phone:     999-999-9999
Mobile Phone:     999-999-9999
email Address:   *
Contact Method Prefered:  
Spouse:   (optional)
How did you learn about BRHS:   (Optional)
Level Regular - $40   Sustaining - $80   Conductor's Club - $100

REGULAR MEMBERSHIP LEVEL= Entitled to one vote, all activities, and all publications during the year.

SUSTAINING MEMBERSHIP LEVEL = Entitled to one vote, all activities, and all publications during the year and you are recognized as a Sustaining Member in a Burlington Bulletin each year. $40.00 of a Sustaining Membership is the portion that covers basic dues, the additional $40.00 is a tax-deductible donation to the BRHS.

CONDUCTOR'S CLUB LEVEL = Joining at the Conductor's Club level entitles you to one vote, all activities, and all publications during the year and provides a $60 tax-deductable donation to the work of the BRHS. Members a this level will receive special recognition with a special pin to wear and will be recognized in a seperate group in our publications when the Sustaining Members list is published.

Term  Years
Payment Method
Print and Mail = Choose 'Print and Mail' if you wish to mail in a check or money order. Following the Confirmation Page you will see a Confirmation Statement of your purchases that you may pirnt out and mail in a copy to BRHS.
Donations Thanks!

DONATIONS = When combined with your annual renewal of $40 or more, donations are tax-deductable.

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