New England Electric Railway Historical Society
Membership Application
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Yes! I want to enjoy the benefits of Museum membership and support vital perservation and educational work. I wish to enroll as a member.

[__] Student, [__] Military,

[__] Disabled

$30 per year
[__] APTA Member $25 intro. rate
[__] Contributing Member $120 per year
[__] Retired over age 60 $30 per year [__] Museum Patron $600 per year
[__] Standard Member $35 per year [__] Museum Benefactor $1,200 per year
[__] Sustaining Member $60 per year [__] Life Member $900

Dues of $500 or greater may be paid in two installments per year, within 90 days of each other.

Enclosed is my membership in the amount of... $___________

Also enclosed is a donation of... $___________

Total............................ $___________

I prefer to pay with: [__] Check [__] Charge Card, Type (Please circle): AMEX - MC - VISA - DISC

Card/Check #: _____________________________ Exp. Date: ___/______ Verification #: _________
- The verification number is a 3 or 4 digit number usually found on the back towards the right side of the signature box.

Signature: _________________________________________

Member Name(s) - Please Print clearly: _____________________________________________

Mailing Address: _____________________________________ Telephone: _________________

City, State, Zip: _________________________________________________________________

Email Address: _________________________________________________________________

Please make checks payable to the "New England Electric Railway Historical Society"
Donations to the NEERHS are tax deductable under Section 501(c)(3) of the Internal Revenue Code.

Please mail this completed application form to:
Seashore Trolley Museum
P.O. Box A
Kennebunkport, ME 04046-1690

Thank you for your generous support of the Seashore Trolley Museum.
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