Membership Application

Date of Application: _________________________

*First Name: ___________________________*Last Name: ___________________________

*Email Address: ______________________________________________________________

*Mailing Address: ____________________________________________________________,

___________________________________________________________________________ City State Zip Code

Phone #s: Home (_____) ___________ Work (_____) ___________ Cell (_____) __________

*Required field

Desired Membership Level (Checks Only Please):

_____Associate ($25 Annually)

_____Supporter ($50 Annually)

_____Benefactor ($100 Annually)

_____Patron ($500+ Annually)

_____Corporate Rail Caucus Sponsorship for one meeting during legislative session ($1000)* _____Other

*Corporate Rail Caucus sponsorships will have their company logo and name prominently displayed during lunch and will be mentioned at the beginning of the meeting, and by the Northern Flyer Alliance, Inc. at the end of the meeting. Kansas Rail Caucus membership is currently at 68 members, with 50-60 attending during each meeting.

On a Windows computer press control print and on a Macintosh computer press command P.

Send this completed form to:

Northern Flyer Alliance 876 N. Diane Dr. Olathe, KS 66061

THANK YOU FOR YOUR SUPPORT!

If you have questions, please contact: Mark Corriston

876 N. Diane Dr.

Olathe, KS 66061