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