Membership Form of the Richmond Civil War Round Table
Applicant Name(s): ___________________________________________________________ Home Address: ________________________________________________________________ City, State & ZIP: ___________________________________________________________ Telephone Numbers: (home) ______-______-________ (work) ______-______-________ E-mail Address: _____________________________________________________________ Type of membership (make selections): ___ Resident (individual) - $35 ___*Nonresident (individual) - $20 ___ Resident (couple) - $45 ___*Nonresident (couple) - $25 ___ Senior Member $20 (over the age of 65 andhas 10 years of membership) ___ Senior Couple $25 (over the age of 65 andhas 10 years of membership) ___ Student member (13-17 yrs old) - $20 ___ Sustaining member - $50+ (dues plus contribution) x $25 Initiation Fee - payable by all new members in addition to annual dues. (*Nonresident is defined as living 50 miles outside of Richmond) Membership Activation Applicants for Resident Membership are asked to visit two regular meetings of the RCWRT. I attended the following RCWRT meetings: 1) ____/____/_____ 2) ____/____/_____ Applicants for *Nonresident Membership are not required to attend two meetings. Please provide a brief description of your interests in the American Civil War: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Monthly newsletter preference (select one): ___ Electronic copy via E-mail (faster and saves RCWRT funds) ___ Printed copy via US mail (slower) Signature of applicant(s): _____________________________________________ Date: ____/____/____ _____________________________________________ Date: ____/____/____ Please make checks payable to RCWRT and return this form with payment to: Sandy Parker, RCWRT Secretary 2425 Falkirk Drive Richmond, VA 23236
