Midwest Railway Preservation SocietyGift Membership Application(Members must be at least 18 years of age) Member Gift Application Gift purchase membership Date(Required) MM slash DD slash YYYY Member's Name (Gift Recipient)(Required) First Last Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneOther PhoneEmail(Required) This gift membership is from:Name(Required) First Last Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneOther PhoneEmail(Required) Where would you like us to send the membership card and information packet?(Required) Send it to me Send it to the gift recipient Do you want us to acknowledge your name in the Welcome Letter?(Required) Yes No (It's a surprise!) Membership subscriptionRegular: $45Platinum: $500Senior (65+): $40Payment MethodPayPal Checkout MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name
