New Member Application

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Personal Information

Spouse/Affiliate Name
Spouse/Affiliate's Email
Fill in if your spouse or affiliate has a different email and wants to receive notices and emailed copies of FOGLight.
MM slash DD slash YYYY
Phone Is*

Vehicle Information

Additional Information

Payment Options*
How will you be submitting payment?
FOGLight Newsletter*
In addition to the email version of FOGLight, would you like to receive the printed version?
Membership Directory*
Do you want your email address published in our Membership Directory? The list is not posted on our website and the emailed version is converted to a format that cannot be hacked. *
This field is for validation purposes and should be left unchanged.