Attendee Information (one NMRA member per form please)
First Name: Last Name:

Address: City

State: Zip Phone: Email:

Guest Names with same address/phone:

NMRA Member? Yes No NMRA Number: Region/Division:

Conference Total $  

Mail Registration & Payment
Once the form is complete, <right click> on the form to <Print> and print 2 copies of this form.
One copy is for your records; the other is to mail with your check payment or by itself if paying by credit card.

Mail your check (payable to: NMRA Michiana Division) and 1 copy of this form to (or just the form if paying by credit card):
Daniel Brewer-NMRA
12164 Covered Wagon Court
Granger, IN 46530

Note: If you would like to pay by Credit Card, Print & Mail your registration to the address above and
<CLICK HERE> to go the instruction page for online payments processed by Square.
PLEASE NOTE: You must mail in your Registration Form even if you elect to pay by credit card.