Form of Application for Membership in the Bay of Plenty Railway Association.

I herewith remit you one shilling as Entry-Money, and the sum of £ ........................................................................................................ towards Preliminary Expenses, and request you to enter my name as a Member of the Bay of Plenty Railway Association; and I agree to sign a Petition or Petitions to Parliament in favour of a Bill or Bills, embodying the views expressed in foregoing Pamphlet: and I further agree to take payment, for any work done by me in the construction of any railway; in the Saurang a Electoral District, in terms of said Pamphlet, in, at least, one half Railway Scrip.