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Membership Application

FMCA Kansas Twister Application & Profile 

Please fill in the blanks and return with your dues to the address below.  Also, if you have one, please enclose or e-mail a digital photo of you and your motorcoach for our profile book.  We look forward to enjoying a rally with you soon.  Thank you and welcome to our chapter!

FMCA #: _________________(Must be a member in good standing with FMCA International)  

Name(s):___________________________________________________________________________

                                           (This is how your names will appear on your name tags so please print clearly)

Address: ___________________________________________________________________________

City:_____________________________________State:__________________ZIP:______________

Telephone _________________________

Cell Phone: (optional) His:___________________  Hers:___________________

E-Mail address ___________________________________________

Birthday: (example 4-15 and 1-12) (His)_____________(Hers)______________

Anniversary: (example 6-20-65) ___________________

Number of Children: __________________ Number of Grandchildren: ________________

Native State: (His)_________________________(Hers)________________________

Retired: (His)_________________________________

             (Hers) _____________________________

Hobbies: (His)____________________________________________________________________

              (Hers)____________________________________________________________________

Make, Model, Length & Year of Motorhome:__________________________________________

CB Handle: (His) ___________________(Hers)____________________

Approximate year you started RVing?________________________________

Emergency Contact: __________________________________________________________

Comments____________________________________________________________________

_____________________________________________________________________________

I enclose $10.00 for my Annual Dues.  Name tags will cost extra.

Please return to:     Kansas Twisters

                                  c/o: Alice Elkins, Secretary              Today’s Date: _____________________

                                  1325 Woodland

                                  Emporia, KS  66801

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Kansas Twisters,
Mar 11, 2014, 1:20 PM
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