Membership Application/Renewal
Date
-
Month
-
Day
Year
Date
FMCA Number
*
Name
First Name
Last Name
Spouse Name
Preferred name for tag (first name will be used if not specified)
Preferred name for spouse tag (first name will be used if not specified)
Email
*
Confirmation Email
confirm email
Application type
New Applicant
Yearly Renewal
The following is ONLY required for NEW APPLICANTS and/or CORRECTIONS
Main Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Phone
Please enter a valid phone number.
Home Phone
Please enter a valid phone number.
Work Phone
Please enter a valid phone number.
Time of year at this location? (start to end)
Secondary Address (if applicable)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Phone
Please enter a valid phone number.
Home Phone
Please enter a valid phone number.
Work Phone
Please enter a valid phone number.
Time of year at this location? (start to end)
Birthdate of primary member
-
Month
-
Day
Year
Month/Day/Year
Birthdate of spouse
-
Month
-
Day
Year
Month/Day/Year
Wedding Anniversary
-
Month
-
Day
Year
Month/Day/Year
Occupation or area of expertise
Coach Information:
Year Model
Converter
Prevost Serial Number
I certify that I own the above described Prevost Motor Coach... (signature)
Clear
Ways I would like to volunteer to help the Prevost Prouds:
Mini Rally planning
Parking at Rallies
Area Representative
Tours
Seminars
Membership
Luncheons
Women's Activities
Golf
Tennis
1st Timers
Style Show
Registration
I would be wiling to serve as a club officer
Newsletter
Prevost Prouds Membership
My Products
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( X )
New Applicant
Includes $100 January-December (non-prorated) dues $25 Initiation fee and 2 name tags
$
125.00
Membership Renewal
Includes $100 January-December (non-prorated) dues
$
100.00
Replacement Name Tags
(NOTE: new membership includes 2 name tags) Replacements will be ready to pick up at next rally you attend.
$
15.00
Quantity
1
2
Credit Card
I acknowledge that 2.9% will be added to my transaction to cover credit card fees.
*
Yes
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Submit
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