Acknowledging JESUS CHRIST as my Lord and Savior, and desiring to be a witness for Him in my

traveling and camping activities, I hereby make application for membership in CAMPERS FOR CHRIST

and will wear the club crest on my jacket and display its decal on my RV as a testimony.

Last Name: ______________________________ His: _________________ Hers: _______________

Street Address / PO Box: ____________________________________________________________

Town / City: _____________________________ State: ____________ ZIP Code: _______________

Home Telephone: (_____) _______________________

Cell Phone(s): His (_____) ________________________ Hers (_____) ________________________

E-mail: ____________________________________________________________________________

His Signature ____________________________ Her Signature ____________________________