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!
