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Northeastern Membership Application

Please Circle one:      New    or    Renewal    Membership

Names: ___________________________________________________________________________________

Mailing address: ___________________________________________________________________________

FMCA# ___________________ Home # ____________________________Cell# ____________________

Email Address:_____________________________________________________________________________

I am enclosing a check made out to the Northeastern FMCA for $15 per year

1 year membership ($15)_______ 2 year membership ($30) ______ 3 year membership ($45) ________

I understand I must remain a member in good standing with FMCA to apply for membership of the NORTHEASTERN Chapter. Please send the check and a completed members application form to:   
Margaret Aquaro ~ P.O. 104 ~ Pinehurst, Mass. 01866.

For more information contact Margaret Aquaro at romag@comcast.net or 978-667-3757


NOTE: A non completed form or check made out incorrectly will be sent back to you.
For more information contact Margaret Aquaro at  romag@comcast.net