CENTER STATE SAMS  APPLICATION TO JOIN

Please fill out the following information:

NAME ________________________________________________________

STREET______________________________________________________

CITY ___________________________STATE ____________ZIP ______

GOOD SAM NUMBER __________________________Exp. Date____________

PHONES: Home ( ____ ) _______________Mobile ( ____ ) ________________

E-MAIL________________________________

Birthday(s) ______________________________

Dependents?_____________________________

RV INFO: Type________________ Length _______ #Slides ______ Other_______

SPECIAL CAMPSITE NEEDS:__________________________________________

CHAPTER MEMBERSHIP DUES: $10.00 per application. Make check payable to Center State Sams.

Dues are renewable at $10/year beginning each calendar year thereafter.

Please return the application to:
Mary Hawkins, Secretary
Center State Sams Chapter
PO Box 32
Brookfield, NY 13314