BNL Family Camping Club

Membership Information Form

Please read the Camping Club Rules and Regulations

YOUR NAME:         First   Last  

SPOUSE'S NAME:    

HOME ADDRESS: (optional)    

BNL LIFE #:             

BNL EXTENSION:     BNL MAIL STOP: 

EMAIL:       EMPLOYMENT STATUS:  Active Retired Guest

HOME TELEPHONE NUMBER:    CELL TELEPHONE NUMBER: 

Children Who Will Be Camping at BNL:

CHILD'S NAME:      AGE:     CHILD'S NAME:    AGE: 
CHILD'S NAME:      AGE:     CHILD'S NAME:    AGE: 
CHILD'S NAME:      AGE:     CHILD'S NAME:    AGE: 
CHILD'S NAME:      AGE:     CHILD'S NAME:    AGE: 

Please Select Type of Unit You Have

Tent Pop-Up Trailer Motorhome Class A Motorhome Class C

State of Registration:  NY AL AK AS AZ AR CA CO CT DE DC FL GA ID IL IN IA KS KY LA MA MD MI MN MO MS MT NC ND NE NV NH NJ NM OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY ME                 License Plate Number of Unit: 
                                                                    (if not applicable - license plate number of your vehicle)

Membership for the first year is $17.00 ($5 initiation $12 dues)

Upon completion of this form, please remit the membership fee to Bob Retundi, Bldg. 1005S BNL extension:  7427.
If you are paying by check - please make it payable to BNL Family Camping Club.