| Return to Renewal Menu | Return to HOME page |
| Thank You for renewing your BRHS Membership! |
Please print this page and then enter the information asked for on the form below.
| Your Name: ___________________________________________ BRHS Member Number: __________________ |
| Address: ________________________________________________________________________________ |
| City _____________________________ State ______________ ZIP/Postal Code _________________ |
| Mobile Phone Number _____________________ House Phone Number _____________________ |
| Email Address: _____________________________________________ |
| Membership Renewal Term -- circle one: [One Year] [Two Years] [Three Years] |
| Membership Level -- circle one: [Regular $40] [Sustaining $80] [Conductor's Club $100] |
| If you do not reside in the USA or it's territories, please add $20 for postage. __________________ |
| Total payment amount enclosed: _______________ |
| Has your contact information changed? -- circle one: [YES] [ NO] |
Mail a copy of this completed form along with your check to: Burlington Route Historical Society |
| Note: Allow 7-10 days for your renewal to be processed. For instant renewal use the on-line renewal feature. |
| Form RN-2022-09-01 |