Print this form, fill it out, enclose a check or money order (made payable to Midwest High Speed Rail Association) corresponding to one of the membership levels listed, and mail to:

Midwest High Speed Rail Association
P.O. Box 805878
Chicago, IL 60680-4120

Name: ___________________________________________________________

Company Name: ___________________________________________________

Address: _________________________________________________________

City: __________________________________ State: ____ Zip: ____________

Email: ___________________________________________________________

Please add me to the email announcement service: ___ yes  ___ no thanks

Home Phone: _____________________ Work Phone: _____________________

Membership Level: __________________________ (from Membership Info page)

Please send me this membership premium: _____________________ (from Membership Info page)

I would like to sponsor this activity: ___________________________ (from Membership Info page)