MEMBERSHIP APPLICATION

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GMC Western States
2212 W. Tonto Ridge Rd.
Prescott, AZ 86305-3938

Membership in FMCA is required. If you are not now a member, you must also appy for membership with FMCA.

GMC Western States Membership Application

FMCA# _______________ or ____ applied for with this application

Last Name _______________________ First Name(s) __________________________________

Address _______________________________________________________________________

City ______________________________ State __________ Zip __________________________

Home Phone (        ) ___________________ Date of Application _________________________

GMC Motorhome: Year ______ Length ______ Model ___________________________________

VIN - TZE_________________ email address __________________________________________

GMC Western States annual dues are $20.00 US. Checks should be made payable to: GMC Western States

FMCA Membership Application

Please provide the following additional information if you are not a member of FMCA:

Occupation __________________________________________

Coach License _____________________ State ____________

Last modified: December 12, 2006