New Member Application

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  Kennebec River Rovers Membership Application

Date Of Application__________________________________________________________________
Good Sam Number______________________________Valid thru_____________________________
Name Mr.______________________________________Date Of Birth__________________________
         Mrs._____________________________________Date Of Birth__________________________
         Anniversary Date______________________________________________________________
Children  1_____________2______________3_______________4_____________5______________
Mailing Address_____________________________________________________________________
Telephone Number________________________________Cell nr_____________________________
E-Mail Address______________________________________________________________________
TYPE OF CAMPER
Pop Up_____Truck Camper_____Tag Alone_____5th Wheel_____Motor Home (A)____(B)____(C)____
Size Of Camper_____________________________________________________________________
Type Of Car or Truck___________________License No._________________State_______________
Reason For Joining The Kennebec River Rovers____________________________________________
______________________________________________________________________________________________________________
Number of days you plan to camp with the group_________________________________________
Number of Winter meetings you plan to attend____________________________________________
How did you hear about this chapter____________________________________________________
______________________________________________________________________________________________________________
Who is the Sponsering Member_________________________________________________________
Comment/s_________________________________________________________________________
______________________________________________________________________________________________________________