HOOSIER CRUISERS MEMBERSHIP APPLICATION AND DUES INVOICE

 HOOSIER CRUISERS MEMBERSHIP APPLICATION AND DUES INVOICE

20___ Annual Dues $25.00

Dues waived for 2022

LAST NAME _____________________                          FMCA # ________

FIRST NAME (S) _____________________________________________

ADDRESS _________________________________________________

CITY ________________________ STATE __________ ZIP _____

PHONE _________________________________________________

E-MAIL ________________________________________________

WOULD YOU LIKE TO RECEIVE YOUR NEWSLETTER BY E-MAIL  YES____ NO _____         (To be distributed to Hoosier Cruiser members only)

Please mail this information with check payable to HOOSIER CRUISERS to:

    Roberta Covington

    1500 W. Crestview Dr.

    Muncie, IN  47302

Check # _____ Cash ________ Receipt # ________ Issue Date _______

Membership renewal _____         or      New membership _____

PLEASE RETURN ENTIRE FORM WITH YOUR DUES.    THANK YOU.

ADDITIONAL INFORMATION IF APPLICABLE

WINTER MAILING ADDRESS (If different from above)

ADDRESS ________________________________________________

CITY _______________________ STATE ___________ ZIP _________

PHONE _________________ E-MAIL __________________________

Dates for Winter Mailing:  START ____________ THUR ____________