FMCA Covered Wagons Application for Membership

Please fill in the blanks and enclose a photograph of you for the chapter directory book which you receive annually as part of your dues. (If desired, you may email a digital photo to webmaster@coveredwagonsfmca.org. If you don't have a photo, we’ll take one of you at your first rally.) According to our Standing Rule #3: Prospective members shall attend two regularly scheduled Chapter business meetings in a 12-month period. If they are interested in joining the Chapter, they will submit an Application for Membership and their annual Chapter dues and receive all Chapter benefits to which they are then entitled.

Thank you and welcome to our chapter!

FMCA #__________________(Must be a member in good standing w/FMCA.)

Name(s):______________________________________________________________________
(This is how your names will appear on your name tags so please print clearly.)

Address:______________________________________________________________________

City:_____________________________State:______________________ZIP:_____________

Home phone: _______________________________

Cell Phone: (optional) His:_________________________ Hers:________________________

E-Mail address: _________________________________

Birthday: (day and month only) (His)____________________(Hers)_______________________

Anniversary: (day, month and year) _____________________Number of Children:________________

Native State: (His)_________________________________(Hers)___________________________

Present or Past Occupation: (His) _________________________ (Hers) _______________________

Hobbies: (His)___________________________________________________________________

(Hers)___________________________________________________________________

Make, Model, Year & Length of Motorhome:______________________________________________

Approximate year you started RVing?________________

Pets (breeds and names) traveling with you:________________________________________________

Emergency Contact:_______________________________________________________________

Comments:______________________________________________________________

Please mark applicable lines below & remit check payable to Covered Wagons. Thank you!

___ $15.00 Annual Dues (e-mail available)   ___ $20.00 Annual Dues (NO e-mail available)

Please add $6.00 for each Name Tag

____ I require a pin-back, instead of the standard magnet-back on name tags

Return to: Covered Wagons Date submitted:______________________
% Bill Keegan

3049 SW 45^th Street,

Topeka, KS 66610 Revised 6/23/10