Individual Membership Application Form
(please amend any details that are incorrect or missing, sign the membership application, fill out subscription / donation payment details then print and mail to the above address or fax to the above fax number)
Name
First Names:
Last name:
Preferred:
Address
Street or Box listing:
Suburb:
City:
Country:
State:
Postcode:
Home email:
Work email:
Preferred email contact: [ ] Home [ ] Work
Phone
Home phone:
Cell phone:
Work phone:
Preferred phone contact: [ ] Home [ ] Work [ ] Cell
Please share my contact details with other members:
Occupation, experience and skills
Occupation:
The Rimutaka Incline Railway project will benefit greatly from Members' experience and skills across a wide range of disciplines, including:
Accounting, marketing, engineering, surveying, planning and resource management, publishing, graphic design, fitting and turning, boilersmithing, welding, painting, building, cabinet-making...
Please list experience and skills you could offer the railway:
Application for membership
I wish to apply for membership of the Rimutaka Incline Railway Heritage Trust, and agree to abide by the Trust Deed (available for inspection on our website or by request).
Signature: ________________________
Date: ____________
Subscription, donation
(Please tick boxes that apply, enclose cheque or fill out credit card details)
Annual Subscription: NZD$45
[ ] I wish to support the Rimutaka Incline Railway by making a donation:
[ ] $250 [ ] $100 [ ] $50 [ ] $25 other:
Donation: NZD$
Total: NZD$
I enclose my cheque / bill my credit card (delete which does not apply) for my membership and any donation.
(Please make cheques payable to Rimutaka Incline Railway Heritage Trust)
[ ] Visa [ ] Mastercard
Name on card: ________________________
Card Number: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Expiry Date: _ _ / 2 0 _ _
Signature: ________________________