vogue_memb_app by ashrafp


                                                   Country Club
                                            Membership Application
                                               January 1st – December 31st

First Name (Husband)                     Last Name                       First Name (Wife)

Street Address or P.O. Box

City                                     Zip                                       State
( )                             ( )                               ( )
Home Phone                      Mobile Phone                      Business Phone

Email Address                                                                      FMCA Member # (Required)

Coach Info             Model                   Length             Year                 Make

National & Regional Chapter __________________                                  Membership Fee               $ 48.00____

Additional Regional Chapter Fee:               $8.00 / each                                          $________________

                                                                                              Total $_______________

                    Mail your application and check payable to: Vogue/Vantare’ Country Club
                     c/o Shirley Roberts, 7737 Stonington Way Court, Kernersville, NC 27284-7723

                       All applications must be received by February 28th to be listed in the
                                 Vogue/Vantare’ Directory to be mailed April 30th

                                     REGIONAL CHAPTER SECTION:
Print the regional chapter in which you reside or near you____________________. Check additional chapters
you wish to join ($8.00 per year per chapter.) If joining a chapter you will be notified of their social activity by
the regional chapter secretary.

    Eastern Chapter                                           Central Chapter
    Maine, Vermont, New Hampshire, Massachusetts,              Arkansas, Kansas, Louisana, Missouri, Oklahoma
    New York, Connecticut, Pennsylvania, New Jersey,           Texas, Mississippi, New Mexico, Colorado, Ohio
    Delaware, Maryland, Virginia, West Virginia,               Wyoming, Iowa, Minnesota, North Dakota, Wisconsin,
    North Carolina, South Carolina, Kentucky,                  South Dakota, Indiana, Illinois, Michigan, Nebraska,
    Tennessee, Rhode Island, Alabama, Georgia, Florida

    Western Chapter
    California, Washington, Oregon, Nevada, Utah, Montana, Arizona, Idaho

Signature ________________________________________________________ Date____________________

To top