Membership Application or Renewal
Dues $45/year


Your birthdate:

mm/dd/yyyy
First Name
Last Name
Middle Name
Nickname (for members card) 		Address
City State   Zip Country
Home Phone

Cell (enter none if you don't have a cell phone)
Email Address (enter none@none.com if you don't have email)
Under what State (or Full-timer) should you appear in the directory?



Former Occupation




Type of Travel/Camping Rig
Hobbies

Where did you learn about LoW?
Emergency Information for your membership card (extra charge: $1.50)
Membership requirement: To become a member of Loners on Wheels, you must be legally single; proceeding with payment (below) is a testament to that fact. If you should marry while being a member, your membership is automatically terminated. If you arrive or attend an official LoW event (one that has been announced in the Newsletter) in the same rig with a person of the opposite sex who is not blood related, your membership will be automatically terminated. Proceeding with payment indicates permission to publish your information in our annual directory. If you wish to withhold any of the above information, please leave that part empty before proceeding with payment. I further agree that the LoW directory is to remain confidental, and that I will never use it, or knowingly allow it to be used, for other than my personal use.
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Membership Duration (Years)
Mailed Newsletter Option
Mailed Membership Directory Option