Spouse First name:
                Last name:
Spouse DOB:

Family living at home (names and birthdates):
Child 1 name: DOB:
Child 2 name: DOB:
Child 3 name: DOB:
Child 4 name: DOB:

Mailing Address: Street:
City: State Zip

Home Phone: Work Phone:
Cell Phone:

Member E-mail: List E-mail on web? Yes No
Spouse E-mail: List E-mail on web? Yes No

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Receive E-Mail notice (on line) or printed and sent US mail: on-line Mail

Occupation:

Operable live steam equipment or under construction:
Do you have track at home? Yes No Someday Gauge:

Special skills or ways to help SVLSRM:

Affiliations with other railroads:

Thank you.

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