APPLICATION FOR "WIN" MEMBERSHIP
*****************REQUIRED INFORMATION ***(Please Print)*****************

TODAY’S DATE__________________________ I WAS REFERRED BY ________________________________________________

IF THIS IS FOR RE-INSTATEMENT: MY PREVIOUSLY HELD WIN # WAS ________________________________________________

NAME: FIRST______________________________  M.I. _________  LAST _____________________________________________

MAILING ADDRESS: ________________________________________________________________________________________

CITY ______________________________ STATE (PROV) ____________ ZIP __________________ COUNTRY ______________

YEAR OF BIRTH ___________ SEX ______ MARITAL STATUS (REASON FOR TRAVELING ALONE) ________________________
RV TYPE: CLASS A OPTIONAL SEASONAL 2ND ADDRESS _________________________________________
CLASS B _________________________________________________________________________
CLASS C _________________________________________________________________________
5TH WHEEL _________________________________________________________________________
TRAILER _________________________________________________________________________
SLIDE-IN-CAMPER EFFECTIVE DATES: _________________________________________________________
BUS CONVERSION
IF YOUR CHUTE DOESN’T OPEN, WHO DO WE CALL TO COME AND GET YOUR RIG: _____________________________________

_________________________________________________________________________________________________________

RELATIONSHIP: ____________________________________________________________________________________________

OPTIONAL INFORMATION FOR WIN BADGE/NEWSLETTER/DIRECTORY
NICKNAME FOR BADGE _____________________________________________________ BIRTHDAY ______/______/_________

TELEPHONE ____________________________________ HAM CALL SIGN ___________________________________________

E-MAIL ADDRESS _________________________________________________________________________________________

I AM:

 WORKING

I TRAVEL:

 FULL-TIME

LIST ME IN THE DIRECTORY UNDER
SEMI-RETIRED

PART-TIME

 FULL-TIME
RETIRED

OCCASIONALLY

 STATE/PROV
MY JOB IS/WAS ___________________________________________________________________________________________

MY INTERESTS AND HOBBIES ARE ____________________________________________________________________________

_________________________________________________________________________________________________________

WOULD LIKE VISITS FROM OTHER WINS                     YES               NO
IF YES:   BY CAR ONLY                         LOCATION:  CITY __________________________________  STATE ______________
           I CAN PROVIDE OVERNIGHT PARKING FOR ___________ RIGS OF MAX LENGTH ____________ ft.
I CAN PROVIDE            WATER                DUMP            LIMITED ELECTRICITY
I certify that the above information is true and complete. I am respectful, responsible, and respectable and I will not use the WIN directory or newsletter for financial gain or commercial purposes, nor will I permit others to do so. I make a commitment to contribute my time and talents to WIN.
_________________________________________________________________________________________________________
(Signature of Applicant)                            Perjury is cause for immediate termination of membership

Mail $70 (or $73.50) and proof of age (A photocopy of driver’s license will do. We will shred it.) to:
W.I.N., P.O. Box 6068, Pahrump, NV 89041-6068