S*M*A*R*T
SOUTHERN OREGON CHAPTER
APPLICATION FOR MEMBERSHIP
Date:
NATIONAL MEMBERSHIP NUMBER: NATIONAL DUES PAID TO
You must be a member of NATIONAL S*M*A*R*T Travel Club to be eligible to join this chapter.
LAST NAME FIRST NAME FIRST NAME OF SPOUSE
STREET ADDRESS P.O. BOX CITY STATE ZIP
MILITARY SERVICE BRANCH STATUS (ACTIVE/RETIRED)
BIRTHDAY SPOUSE BIRTHDAY ANNIVERSARY DATE
PHONE NUMBER EMAIL CELL PHONE
SIGNATURE
First Year Dues; FREE FREE FREE
Annual dues; $10.00
Make checks payable to
SO OREGON SMARTRETURN TO:
TONI PYATT, MEMBERSHIP, SO SMART2206 BLUE HERON CT.
GRANTS PASS, OR 97526
(541) 476-4155