| Granite Staters Membership Application | ||
|---|---|---|
| No person may become a member of the Granite Staters Chapter unless he/she is a member in good standing of Family Motor Coach Association (FMCA) | ||
| This membership is New ____ Renewal ____ For Information only ____ | ||
| FMCA # ______________________________________ | FMCA Expiration Date _____________________________ | |
| Pilot's Last Name _______________________________ | Pilot's First name _________________________________ | |
| Co-Pilot's Last Name ____________________________ | Co-Pilot's First Name ______________________________ | |
| Mailing Address ________________________________ | City ___________________ State ________ Zip ________ | |
| Tel # ________________________________________ | E_mail __________________________________ | |
| I/we have paid my/our dues or have applied for FMCA membership. Enclosed is a check and I/we understand that it is for dues and entitles me/us to membership in good standing in the Granite Staters Chapter of FMCA for the period circled below. (no cash please) PLEASE PRINT MATERIAL IN ABOVE SPACES. | ||
| Signature __________________________________ | Date _____________________ | |
| Dues: $15.00 to May 31, 2011
Dues: $65.00 to May 31, 2015 Circle one of the above! |
Make check payable to GRANITE STATERS
Print and fill this form, and mail to: Barbara Smith - Membership Chm 41 Blanchard Road Harvard MA 01451 E-mail: bsmit59@hotmail.com | |
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