APPLICATION FOR MEMBERSHIP

DATE: _______________________             FMCA # ________________ REQUIRED
CCI # __________________ REQUIRED

Your Name  ___________________________________________________________

Partner’s Name _________________________________________________________

To be a member of the Country Coach Nor’Easters Club, you must:

1. Be a member in good standing of Family Motor Coach Association (FMCA)
   
2. Be a member in good standing of Country Coach International (CCI)
   
3. Be a resident of the Northeast (as defined by Country Coach International)  States included are:  DE, NJ, CT, RI, MA, MD, NY, PA, VT, NH, ME & NORTHEAST PROVINCE OF CANADA (NEW BRUNSWICK, QUEBEC AREAS)
   

PRIMARY MAILING ADDRESS

Street _________________________________     City __________________________

State  ________________   Zip ____________

Residence Phone (       )  _________________   Business Phone (       ) _______________

E-Mail Address ________________________________  Cell Phone (       ) ___________

Dates at this address _______________________________________________________

ALTERNATIVE MAILING ADDRESS

Street _________________________________      City___________________________

State  _________________ Zip ____________

Residence Phone (       )  _____________  Dates at this address _____________________

INFORMATION

Coach Model _______________________ Length _____________  Year __________

Hobbies/Talents  _______________________________________________________

                            _______________________________________________________

Your Signature      _______________________________

Partner’s signature _______________________________

Membership fee is $25.00 (Calendar year).  Check payable to “Country Coach Nor’Easters” should be sent to Millie Green, Treasurer, 36 Sunnyview Drive, Phoenix, MD  21131

DUES FOR COUNTRY COACH NOR’EASTERS
ARE CURRENTLY (2010) $25 PER YEAR PAYABLE IN ADVANCE
IN SEPTEMBER (FOR THE FOLLOWING CALENDAR YEAR)

Checks for renewal dues should be made payable to Country Coach Nor’Easters and mailed to Mary Ann Moran, 164 Shore Road, Clinton, CT  06413

(Members should make note of the September due date as notices are not sent out)