Membership Application Form The Northwestern Pacific Railroad Historical Society A non-profit 501(c)(3)organization Name First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Email PhoneMembership LevelSelect Your Membership CategoryStudent (Under 18) – $23Regular – $45Family – $68Sustaining – $90Contributing – $180Life – $900Nonprofit Redwood Empire Library or Historical Society – $23Please check if you are renewing an existing membership. Yes, I am renewing Add First Class or International Mail Yes – $10 No Additional Donations to Reserve Special Funds.Fill in amounts you would like to donate to each. The membership portion of the donation ($45/$900) is not deductible.Baggage Car # 605 Fund Coach Car # 29 Fund P&SR Boxcar #2 Fund P&SR Caboose #1 Fund Stindt Engine # 112 Fund Hogarty Library Fund Other Donation I would like to donate to another fund Other Amount: Specify fund: Total Some questions so we can know more about our members and how to serve them better.Do you have a NWP connection? Yes No What is your NWP connection? Are you a modeler? Yes No Railroad Scale If you can volunteer, indicate your interest in these activities: Archives/Library/Museum Quarterly Programs Depot Restoration P&SR Caboose # 1 Car # 29/Baggage # 605 Awards Dinner Committee Administrative Assistant Other Other volunteer interest: Privacy PreferenceWe sometimes make our membership list available to carefully screened organizations whose products and services may be of interest to you. If you prefer not to have your name made available, please indicate. Do not share my information SOCIETY DUES POLICY: Dues are payable as of January 1 of each year. There is a 90-day grace period. Members who do not renew by March 31 of each year are dropped from our roster. New members joining after October 1 are considered paid in full for the next membership year. There is no grace period for first class mail privileges.Payment MethodPayPal CheckoutCredit Card American ExpressMasterCardVisaSupported Credit Cards: American Express, MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name
