Page 11 - Summer 2020 Travelore 50

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: __________________________
Membership in FMCA is required for full Diesel RV Club affiliation.
Street – no PO box please Phones: _____________________
Home or Office
E-mail Addresses: ______________________________________
Pilot
Occupations (if retired, former occupations):
______________________________________________
Pilot
Emergency Contact: ___________________________
Name – normally not with you Newsletter Delivery Choice (check one): Email Only [ ]
[ ] Regular, provide FMCA Number ____________ ____________________ ____________________
[ ] ForumPlus ____________________
REGULAR MEMBERSHIP DUES ARE $25 PER YEAR
Pilot – Last
Co-pilot – First
Co-pilot – Last ________________
Postal Code ________________ Postal Code
_______________
City _______________
________
State/Prov ________ State/Prov
City ____________________
_____________________
Pilot’s Mobile
Co-pilot _________________________
Relationship Email & Postal [ ]
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
Referred by Member: __________________________________________ Your RV Information:
Co-pilot’s Mobile _______________________________________
Co-pilot
_______________________________________________
_________________
Telephone
Postal Only [ ]
DRVC Travelore - Page 11
VIN: _______________
----- FOR CLUB USE ONLY -----
Amount Received: ___/___/____ Date Received Check # ______
$ ________ ___/___/____ Renewal Date Cash _______ Revised March 2019