MEMBERSHIP / RENEWAL
APPLICATION
Roadtrek International Chapter FMCA
A Roadtrek Owners Club
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Application Information

* Required Entries

Date:

Is this a new or renewal of membership?

New Membership
Renewal

Period: 1,2,3,4 or 5 years:

Roadtrek Chapter Dues are $15 per year. New applications received before July 1 expire on December 31. New applications received between July 1 and December 31 will receive credit for the following year. All dues expire on December 31 of the "Dues pd thru" date on your newsletter mail label.

*FMCA #
Enter your membership number with the leading letter.

Primary Member

*First Name
Please don't put Joe & Mary, put the second name in the box below.

*Last Name

Secondary Member (Spouse/Other)
If none, leave blank.

First Name

Last Name
(If different, just overtype the default.)

Other Family Members (please don't list your pets!)

Mailing Address

*Addr1

Addr2

*City

*State/Province

Region

*Zip+4/PC Complete 9 digit Zip Code -- Zip+4

Postal Address:

Email Address

*Primary Email

Secondary Email (Leave blank if none.)

*Primary Phone

*Roadtrek Model*Vehicle Make*Model Year

Directory Notes and Changes Since Last Renewal

H: Willing to assist with mechanical problems.
P: Welcomes phone calls when in the area.
V: Welcomes visits, but call first.
M: Internet access and is willing to share.

*Any address, email or phone number changes since last Renewal?
  Required entry.

Member Directory

The chapter publishes a directory of members which can be found in private area of the website. Once you become a member you will be able access the directory.

There are members who live all over the US and Canada and many are willing to assist with help and information.

Roadtrekers travel and are very knowledgable about various travel destinations. They can also share information about Roadtrek systems.

Please review your entries carefully and either click the PayPal button (Buy Now) or the Pay with a Check button to mail in your check. No need to print the form, just write your FMCA number on the check.

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If you must pay by check, please enter the check number below so the treasurer can match it with your registration information.

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This information will be saved and used to update the user database.

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