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Today's date _____/______/________		Applying for:  ______Regular Membership ($180.00/yr) 
				   			       ______Youth Membership ($90.00/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) ________________________________________________


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 lifestyle allow, become familiar with the club's members,
methods, and history, and pay annual 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 (including current $25.00 layout enhancement fee and $100 initiation fee (within 6
months)) 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

Current:  September 2012