Print Out This Form Fill It Out And Mail It In
Last Name_________________________ First Name____________________MI_______
Date of Birth_____/_____/_____ E-mail Address__________________________________
Address__________________________________________________________________
City_____________________________ State___________ Zip______________________
Home Phone_________________________ Work Phone___________________________
Fax Number__________________________ Occupation___________________________
Your Main Machine_________________________________________________________
Your Backup Machine_______________________________________________________
Family Members Names
Relationship
Date of Birth
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
2009 Dues
Regular Member .............................$15.00 __________
Family Plan...... ...............................$25.00 __________
Junior Member ......(17 & under).....$10.00 ___________
Senior Member ................................$8.00 ___________(After 1st year
as Regular Member)
Optional FMDAC Membership Dues $5 -- per person (**Must be a member of the
SJMDC**)
Number of FMDAC Memberships __________ X $5.00 __________
Total Amount Enclosed $________________________
Do you need a membership card? yes / no
Would you be interested in receiving your "Digger" via email to save the club postage? yes/no (if yes make sure you filled in the email address above!)
Make checks payable to SJMDC. Mail to:
SJMDC
Membership Secretary
PO Box 292
Haddon Hts., NJ 08035
Any question click here to send an
e-mail.
Allow 4 to 6 weeks for your membership card to be mailed to you.