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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 SMART

RETURN TO: TONI PYATT, MEMBERSHIP, SO SMART

2206 BLUE HERON CT.

GRANTS PASS, OR 97526

(541) 476-4155