South Shore Model Railway Club

Membership Application

(You must be 18 years or older to apply for membership)

Name:  ________________________ Home Phone: ________________

Address(1): ____________________ Work  Phone: _________________

Address(2): ____________________ E-Mail: _______________________

City/State/Zip:  __________________       FAX: ___________________

Emergency Contact: _______________   Phone Number: ____________

Relationship: _________________________

In what manner did you hear of the club?

What is your experience in the hobby? (none required)   _____extensive _____ varied _____ limited _____ none

Briefly describe your experience, if any:

Do you have a special interest? (none required) _____electrical    _____modeling    _____trackwork   _____scenery

Other areas of interest?

Comments:

Have ever been a member of this club or any other model railway club or rail organization?   _____ Yes  _____ No

If yes please explain:

  Did you leave the organization(s) in good standing?     ________Yes      _______No

Have you read and understood the prerequisites for membership?     ____ Yes   _____ No

If you don’t understand, please contact the membership chairman for clarification

  ________________________  _______________________  ________________________

              Applicant                                         Sponsor                                  Membership Chairman

Please forward completed application with $30 to SSMRC, P.O. Box 170, Hingham MA  02043-0170

Date Accepted: _______________   Date eligible for full Membership: ____________________