Enter Name(s) as they are to appear on badges:

Today's Date
Member #1 Name
Member #2 Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country	United States Canada Mexico
Work Phone
Home Phone
E-mail
Monaco Model
FMCA Number

Initiation Fee: $25,  Dues $15

Print this form and mail with your check for $40 to:

    Bill Miller
    11085 Big Canoe
    Big Canoe, GA 30143