Membership Application

Chapter of FMCA                                                                                                     cuatroestados.com

Cuatro estados MEMBERSHIP APPLICATION

Name(s): _______­­_________________________________________________________   Date:______________

Address: _____________________________________________________________

FMCA #:_______________

Home Ph No.:____________________ Cell(s): His:_____________________  Hers:________________________

Email(s): His: _____________________________________ Hers:_______________________________________

(Put an asterisk* by the email address to which you want our monthly newsletter sent; it can be both.)

RV unit type (yr, model, length):_________________________________________________________________

License #____________________  Tow Car______________________________ License#__________________

Birthday (mo/date only) His:______________  Hers:_____________  Anniversary (mo/date) ______­­­____________

Need Handicap facilities? ______________________________________________________________________

Emergency Contact (phone, name):_______________________________________________________________

Cost to join is $40/couple, $20/single, which includes name badges and 1st year dues.  Annual dues thereafter are $15/couple, $7.50/single. You will also receive our annual Membership Directory and monthly newsletters.  (Newsletters are sent via email unless you specify otherwise.)  By completing this application, you agree to allow us to print your information in our Membership Directory, and to not use the directory information for anything other than chapter activities/business.

Make check payable to Cuatro Estados and send to:

Lynn Buckingham

CUATRO ESTADOS Treasurer

11508 Nassau NE

Albuquerque, NM 87111

 

WELCOME TO THE BEST IN THE WEST!

 

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