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Brevard County Model Railroaders

(please note than name may change by future membership vote)

Application for Membership

First Name: ____________________________________________________________

Last Name: ____________________________________________________________

Spouse Name: __________________________________________________________

Address: _______________________________________________________________

City: _____________________________________ State: ________ Zip: __________

Phone: ________________________________________________________________

E-Mail: ________________________________________________________________

Do You Have An Operating Layout: Yes ( ) / No ( )               Layout Size: _________                                          Scale: G ( ) O/Lionel ( ) S/Marx ( ) HO ( ) N ( ) Z ( )

Membership Type:

Regular              ( ) - $10 per month

Includes All Family Members (Living At The Same Address)

(please note that dues may change by future membership vote)

Children’s Names/Ages:

              ________________________________________________________

Junior Members - Ages 8 to 18 / Tot Members - Under Age 8

All New-Member Will Undergo A 3-Month Probationary Period.

Since we are still working on becoming an IRS 501c7 and getting a club Bank Account - All dues can currently be paid by Cash or Check (payable to Mike Heindl), We are also working on ZEFFY payments for dues & donations!

Completed Applications with Dues Payments can be mailed to:

Mike Heindl, 351 Decordre Road SE, Palm Bay, FL 32909