Application Form — “Sponsor a length of track”
(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)
I wish to sponsor a length of track on the Rimutaka Incline Railway by the following plan:
Bronze plan [ ]
Length of track located anywhere in the Maymorn yard, sponsored sleeper marked in the virtual locator and in a register held at Maymorn station, and recognised with a certificate.
The sleeper will be fitted with a plate engraved with current year and serial number for ready identification.
__ lengths @ $100 = $_____
Silver plan [ ]
Length of track located in a readily accessible location in the Maymorn yard, sponsored sleeper marked in the virtual locator and in a register held at Maymorn station, and recognised with a certificate.
The sleeper will be fitted with a plate engraved with your choice of year and serial number for ready identification.
Plan includes 1 year’s membership of the Trust.
__ lengths @ $500 = $_____
Gold plan [ ]
Length of track located in a readily accessible and highly visible location in the Maymorn yard, sponsored sleeper marked in the virtual locator, in a register held at Maymorn station and on a plaque that will eventually be displayed on the station building. Your sponsorship will be recognised with a certificate and an optional biography that will be on public display — an ideal tribute for a family member or colleague (with their permission). Anonymity can also be catered for.
The sleeper will be fitted with a plate engraved with your choice of inscription for ready identification (we will be in contact to discuss inscription options).
Plan includes Life membership of the Trust.
__ lengths @ $1,000 = $_____
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
Application for membership
I also 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)
Silver plan includes 1 year’s subscription, Gold includes Life Membership.
If you have selected the Bronze plan you may also wish to join as a member of the Trust.
Annual Subscription @$45: $______
[ ] I also wish to support the Rimutaka Incline Railway by making a donation:
[ ] $250 [ ] $100 [ ] $50 [ ] $25 other:
Donation: $______
Total: $______
(All amounts are in New Zealand dollars)
I enclose my cheque / bill my credit card / please send me an auto-payment form (delete which does not apply) for sleeper plan chosen, 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: ________________________