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		    KENTUCKY & INDIANA MODEL RAILROAD CLUB 
			  MEMBERSHIP APPLICATION

Today's date _____/______/________		Applying for:  ______Regular Membership ($120.00/yr) 
							           ______Youth Membership ($60.00/yr)

Payment date ______/______/_______ 	CK# _________	Amount  $____________

Full Name________________________________________________________________________________________
		(last)				      (first)				(middle)

Your home phone (_______) _______-__________  Your cell phone (______)_______-__________

Your e-mail address ______________________________________________

Your mailing address (street or PO box) ________________________________________________

City__________________________State___________________ZIP_________________________

Nickname (if you use one)________________Birth mm/yyyy___________Birthplace___________

Married?  _____Yes     ______No      Spouse's name (if yes) _______________________________

Special talents or expertise___________________________________________________________ 

_________________________________________________________________________________

Favorite Railroad(s)_________________________________________________________________

Preferred modeling era in time__________________________ Scale__________________________

My K&I Mentor is _________________________________________________________

SIGNATURE______________________________________________Date _______/_______/_______

I acknowledge that with submission of this form and payment of my first month's dues I am beginning a six-month probationary period, during which time I will be expected to participate in club activities and events as frequently as my schedule and life style allow, become familiar with the club's members, methods, and history, and pay monthly dues and a layout enhancement fee. I understand that should my participation in club activities during this probationary period be insufficient, inadequate, or un-satisfactory, my candidacy may be suspended or terminated by the club's Superintendent. I realize that my membership in the K&I requires a majority vote of the members present at a duly-convened monthly business meeting, and that to be considered I must make myself familiar to those who will consider my candidacy. Upon successful completion of my probationary period, I will confirm my commitment to the K&I by making written application and attending my confirmation. I understand that membership in the K&I is contingent upon membership in the National Model Railroad Association (NMRA) and that a lapse in NMRA membership automatically terminates my K&I membership. Finally, I understand that dues and fees once paid are not refundable for any reason.

Submit this application and a check made payable to:  Kentucky & Indiana Model Railroad Club 
to:  Ed Brennan, Treasurer, K&I Model Railroad Club
      9410 Habersham Drive
      Louisville, KY 40242-2312
					
PLEASE SAVE A COPY FOR YOUR RECORDS



Current:  Feb 2012

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