This application is for a [ ]
NEW [ ] RENEWAL membership in the Thousand
Island Voyageurs (TIV) .
Our FMCA number is ________________ or, we applied
for FMCA membership on ______/______/______
Pilot Last Name: ___________________________________
First: _________________________________
Co-Pilot Last Name: ________________________________
First: _________________________________
Pilot's Birthday (opt): ____________ Co-Pilot's
Birthday (opt) ____________ Anniversary (opt)
_________
Mailing Address:
_________________________________________________________________________
City: _____________________________ State/Prov:
_____________________ Zip/PC: ________________
Phone: (_________)_________________________ Cell/Alt
Phone: (__________)______________________
Email:___________________________________________________________________________________
Motorhome
Make/Model:________________________________________ Length
_______ # Slides ______
AS MEMBERS WE AGREE TO ABIDE, TO THE BEST OF OUR
ABILITY, BY THE PROVISIONS OF THE FAMILY MOTOR COACH
ASSOCIATION INC. “CODE OF ETHICS” IN ORDER TO HELP
BUILD A GOOD PUBLIC IMAGE FOR ALL FAMILY MOTOR COACH
OWNERS.
Fiscal Year: October 1st to
September 30th
Annual Dues: $10.00 per coach/2 persons
Due Oct. 1 each year
For new members, a one time Initiation Fee of $5.00 applies for one (1) COACH to
recover setup costs. Please make your check or money order PAYABLE TO:
Thousand Island Voyageurs (TIV). A $25 charge will be
applied for insufficient or non-negotiable checks.
Return this application to:
Dues: $______________
Dan Bazinet
VP Membership
2095 Fillmore
Crescent
Initiation Fee: $______________
Ottawa, Ontario
K1J 6A1
TOTAL ENCLOSED: $ _____________
Do you have questions? Email
us!
Date: ________/________/_________
SIGNATURE:
_______________________________________________
