Page 13 - DRVC Travelore Winter 2019
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             DRVC Travelore - Page 13
      Diesel RV Club – Membership Enrollment Form
Mission Statement: We are a club for RV owners with an interest in diesel engines including how to maintain them, get maximum performance, and keep repair costs to a minimum. Rallies always include social activities and technical seminars and are conducted in all areas of the US.
Membership Type (check one): Names: ____________________
Pilot – First
Mailing Address: ___________________________
Street/P.O. Box
Shipping Address: __________________________
Street – no PO box please Phones: _____________________
_______________ City
_______________ City
________ State/Prov ________ State/Prov
Membership in FMCA is required for full Diesel RV Club affiliation.
Home or Office
E-mail Addresses: ______________________________________
Pilot
Occupations (if retired, former occupations):
______________________________________________ Pilot
Emergency Contact: ___________________________ Name – normally not with you
_______________________________________ Co-pilot
_______________________________________________ Co-pilot
[ ] Regular, provide FMCA Number ____________ ____________________ ____________________
[ ] ForumPlus ____________________
Pilot – Last
Co-pilot – First
Co-pilot – Last ________________
Postal Code ________________ Postal Code
____________________ Pilot’s Mobile
_____________________ Co-pilot’s Mobile
Newsletter Delivery Choice (check one): Email Only [ ]
Referred by Member: __________________________________________
Your RV Information:
Coach Mfg: _____________ Model: ______________ Length: _______ Slides: ______
Engine Mfg: ___________ Model: _____________ Rated HP: __________ Serial No:_____________
Make checks payable to Diesel RV Club and mail to: Diesel RV Club
3916 Potsdam Ave. PMB #1107
Sioux Falls, SD 57104-7048
Note: Please feel free to duplicate for other FMCA members who are interested in the Diesel RV Club Membership. PayPal payment option available on the Club website – www.dieselrvclub.org
_________________ Telephone
_________________________ Relationship
Postal Only [ ]
Email & Postal [ ]
VIN: _______________
  ----- FOR CLUB USE ONLY -----
Amount Received: ___/___/____ Date Received Check # ______
$ ________ ___/___/____ Renewal Date Cash _______ Revised March 2019
REGULAR MEMBERSHIP DUES ARE $25 PER YEAR




















































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