GMC GREAT LAKERS MOTORHOME CLUB, INC.

CHAPTER OF FMCA

APPLICATION FOR MEMBERSHIP

MEMBERSHIP REQUIREMENTS: 1) Ownership of at least one-third of a class "A" "TZE" GMC Motorhome.

2) Full membership in good standing of the Family Motor Coach Association.

Please type or print legibly with black pen

NAME________________ ________________ ________________

(Last) (First) (Spouse's Name)

ADDRESS_______________________________________________

________________ ________________ _____________

(City) (State) (Zip code + 4)

TELEPHONE #______________________FMCA # ____________

(Area code & Number) -

E-MAIL ADDRESS____________________FAX #_____________

WINTER ADDRESS______________________________________

________________________________ ______ _______________

(City) (State) (Zip code +4)

TELEPHONE #__________________

(Area code & Number)

GMC CLASS "A" MODEL "TZE" VICHICLE IDENTIFICATION NO.____________________

_

MODEL AND YEAR ___________________________________ LENGTH_______________

RECOMMENDED FOR MEMBERSHIP BY: ________________________________________

PLEASE COMPLETE THE ABOVE AND FORWARD WITH YOUR CHECK FOR $50.00 (U.S FUNDS)

(INITIATION FEE OF $25.00 AND ANNUAL DUES OF $25.00) MADE PAYABLE

TO GMC GREAT LAKERS MOTORHOME CLUB, INC. TO:

GMC Great Lakers Motorhome Club, Inc.

%Richard Wilson

139 John Street

Plain City, Ohio 43064-1216

SIGNATURE OF APPLICANT__________________________________________ DATE_____________

_________________________________________ __________________________________________

(Treasurer) (Secretary)

_____________________________ ______________________________

(Date) (Date)

Form Revised 1106