"WIN" MEMBERSHIP RENEWAL
*****************REQUIRED INFORMATION ***(Please Print)*****************

TODAY’S DATE__________________________ WIN MEMBERSHIP NUMBER ___________________________________________
RENEWAL IS FOR     1 YEAR ($60)     2 YEARS ($114)     3 YEARS ($162)  (Please add $3.50/yr for outside USA)
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

Renewal rates are $60/yr for one year, $57/yr for two years, or $54/yr for three years.  Please add $3.50/yr for outside the USA.  Mail the selected renewal to:
W.I.N., P.O. Box 6068, Pahrump, NV 89041-6068