Membership Application

[You will have to print this in order to complete, and send via regular mail with your check.]
Today’s Date_______________

NAME(S):                                                                                                    

FMCA #_______________   

ADDRESS:___________________________________________________________

CITY/STATE/ZIP:___________________________________________________________________________________

E-MAIL ADDRESSES: His_______________________ Hers______________________

HOME PHONE:______________________

CELL PHONES:His_______________________ Hers__________________________

MOTORHOME (yr,model,length):_________________________________________

LICENSE:_____________

TOW CAR (yr, model):_______________________________________

LICENSE:________________

BIRTHDAY (MO/DAY):  HIS:____________  HERS:______________ 

ANNIVERSARY:________________

 EMERGENCY CONTACT NAME/PHONE:______________________________________

DO YOU REQUIRE HANDICAP FACILITIES?(specify)_____________________________

 COST TO JOIN (includes badges and 1st year dues):  $40.00 per couple; $20.00 for single.  (If you join after Oct. 1st, your dues for the following year are also covered.)  Dues also include our monthly newsletter and our annual directory.

To be a member and remain a member of Cuatro Estados, you must maintain your FMCA membership.

ANNUAL MEMBERSHIP DUES THEREAFTER:   $15.00 per couple; $7.50 for singles.

Chapter Rallies are generally held around the first or second week/weekend of each month.  A small rally fee (range $3-5/person) is charged at each campout to cover food & any other items provided.   Details of rally activities and camping costs are covered in our monthly newsletter & website.

 A Membership Directory is published annually and a copy furnished to all Cuatro Estados members.  By completing this application, you are giving your permission for us to include this information in the directory.  It is not shared with anyone other than our members.

 MAKE CHECK PAYABLE TO CUATRO ESTADOS AND MAIL TO:

 Lynn Buckingham, Cuatro Estados Treasurer

11508 Nassau NE, Albuquerque, NM 87111

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