Page 11 - Summer 21 Edition of Travelore

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 in FMCA is required for full Diesel RV Club affiliation.
Membership Type (check one): Names: ____________________
Pilot – First
Mailing Address: ___________________________
Street/P.O. Box
Shipping Address: __________________________
[ ] Regular, provide FMCA Number ____________ [ ] 1st Year Free [ ] Forum Plus ____________________ ____________________ ____________________
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 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