PWMRC Membership Application

PWMRC Membership Application Personal Information
	Name: ________________________________________________________________ Address: ________________________________________________________________ ________________________________________________________________ City: ______________________________ State ________ ZIP ____________ Home Telephone: (______) __________________________ Work Telephone: (______) __________________________ E-Mail: _________________________________________________________________ Date of Birth: ___________ / ___________ / ___________ Questionnaire Do you have a model railroad layout? Yes ___ No ___ Scale(s): __________ What are your particular interests in model railroading? (rolling stock, scenery, etc.) __________________________________________ _________________________________________________________________________ Other railroad interests: _______________________________________________ Related skills: _________________________________________________________ Railroad affiliations (NMRA, etc.): _____________________________________ Other information about you: ____________________________________________ _________________________________________________________________________ Parental Consent (For minors under 18 years of age) I give my permission, as a parent or legal guardian,for my son/daughter to become a member of the Prince William County Model Railroad Club. Signature: __________________________________________ Date: _____________
PWMRC Use Only Date Received: ____________ PW Number Assigned: _______ Appl. Fee Enclosed? _______ Reviewed by: ___________ Check Number: ___________

Personal Information

Name:    ________________________________________________________________

Address: ________________________________________________________________

         ________________________________________________________________

City:    ______________________________   State ________ ZIP ____________

Home Telephone: (______) __________________________

Work Telephone: (______) __________________________

E-Mail: _________________________________________________________________

Date of Birth: ___________ / ___________ / ___________

Questionnaire

Do you have a model railroad layout?  Yes ___ No ___ Scale(s): __________

What are your particular interests in model railroading?
(rolling stock, scenery, etc.) __________________________________________

_________________________________________________________________________

Other railroad interests: _______________________________________________

Related skills: _________________________________________________________

Railroad affiliations (NMRA, etc.): _____________________________________

Other information about you: ____________________________________________

_________________________________________________________________________

Parental Consent (For minors under 18 years of age)

I give my permission, as a parent or legal guardian,for my son/daughter
 to become a member of the Prince William County Model Railroad Club.


Signature: __________________________________________ Date: _____________

PWMRC Use Only

Date Received:

____________
PW Number Assigned:

_______
Appl. Fee Enclosed?

_______
Reviewed by:

___________
Check Number:

___________