[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
