GREAT LAKES COACHES FOR CHRIST
(Indiana, Michigan, Ohio & Ontario)
MEMBERSHIP / RENEWAL APPLICATION
(Information will be used for the next directory.)
MAKE CHECKS PAYABLE TO: Coaches For Christ
MAIL TO: Jim Rike
1840 King Richard
Parkway
Miamisburg
OH 45342-2718
(937) 859-6158 - Click Here to send Email
Applicants must be members of the Family Motor Coach Association (FMCA).
FMCA # _____________________ Date of Application
___________________
New/Renewal $10.00 (if received after October 1st, will cover remainder of
this year
and all of next year).
_______________________ _____________________
__________________
Last Name
First Name Mate's First
Name
___________________________________ ____________________________
Home Address
City
________ ___________ ________________
________________________
State
Zip Code
Telephone Number
E-mail Address
_________________________________________________________________
* SUMMER MAILING ADDRESS (If different from above)
__________________________________ ____________________________
Home Address
City
________ ___________ ________________
________________________
State
Zip Code
Telephone Number
E-mail Address
_________________________________________________________________
* WINTER MAILING ADDRESS (If different from above)
__________________________________ ____________________________
Home Address
City
________ ___________ ________________
________________________
State
Zip Code
Telephone Number
E-mail Address
Dates for Winter Mailing: Start ________________ Thru
____________________
You are encouraged to order badges from Mr. Ken Badges 'N Signs
at the next
G.L.A.S.S Rally or Click Here for mail Order Form.