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____________________________ ______________________________ ________ _____________________
Last Name First MI Spouse
__________________________________ _________________________________ ___________ __________
Street Address City State Zip
_______________________________ ____________________ Active/Retired MH 5W TT Van Other
Phone Number Branch of Service (Circle one) RV Type (Circle One)
_______________________________ ____________________ ____________________ _______________
Email address Your birthday month Spouse birthday month Anniversary month
______________________________________________
Your Signature
Enclose $10.00 Annual Regular Membership Fee; $5.00 Annual Regular Membership Fee for Single or Associate
Member. (January 1 through December 31)
Enclose $5.00 1/2 Annual Regular Membership Fee; $2.50 1/2 Annual Regular Membership Fee for Single or
Associate Member. (July 1 through December 31)
Make check payable to: SMART T/O Chapter
Return Application and payment to: Marlene Campbell, Treasurer
208 Glenn Dr.
Hurst, TX 76053
Chapter Membership Number:________________ (To be filled in by Treasurer)
Date received: ________________________ by _______________________________________________
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RECEIPT
Date received:________________________________________ Amount received ____________________
Dues from:___________________________________ To _______________________________________
By ______________________________________________
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SPECIAL MILITARY ACTIVE RETIRED TRAVEL Club
TEXAS/OKLAHOMA (T/O) CHAPTER
MEMBERSHIP APPLICATION
National S*M*A*R*T Membership No.________________
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