|
NW Trek Fun Club Member Information Sheet |
|
No information gathered from
this form will be disseminated without your knowledge and consent except
to NW Trek Fun Club members and FMCA for legitimate club activities.
Any member receiving your information is required to protect your
privacy in this manner also. |
| Member Names: |
|
First Name* ___________________________________________ |
|
Last Name* ___________________________________________ |
|
Partner First Name ______________________________________ |
|
Partner Last Name ______________________________________ |
|
Preferred Nick Names ______________________________________
( For use on Club Id. Badge) |
| Mailing Address: |
|
P.O. Box or Street* _______________________________________ |
|
City* __________________________________________________ |
|
State or Province* ________________________________________ |
|
Zip Code* ______________________________________________ |
| Additional Contact Info: |
|
Email Address* ______________________________ |
|
Telephone __________________________________ |
|
Cell # __________________________________ |
|
FMCA Number* ____________________________ |
| Coach Info: |
|
Model:*
______________________________ |
|
Year:*
_______________________________ |
|
Power/engine:________________________ |
| Additional Information You Wish Included: |
| ___________________________________________________________ |
| ___________________________________________________________ |
| ___________________________________________________________ |
|
| *
Required Information |
| . |
| If you decide to join, please print and complete
this application form and send it, with a check for $10, payable to
NW TREK Fun Club, to Ken Schindler, Secretary -
663 Three Rivers Rd., Forks, WA, 98331 |
