Membership Application — Thor Diesel Club

Membership Level

Organization (not required)

Member Since

Renewal Due On

Set by the membership chair on approval.

Pilot First Name *

Pilot Last Name *

Pilot Email *

Pilot Mobile Phone

Pilot Home Town

Pilot State / Province

Pilot Nick Name

Pilot Food Allergies

Pilot CPR Certified

Pilot First Aid Certified

Co-Pilot First Name

Co-Pilot Last Name

Co-Pilot Email

Co-Pilot Mobile Phone

Co-Pilot Home Town

Co-Pilot State / Province

Co-Pilot Nick Name

Co-Pilot Food Allergies

Co-Pilot CPR Certified

Co-Pilot First Aid Certified

FRVA Number

First Names

Mailing Address

City

State / Province

Zip / Postal Code

Region (auto-filled from state)

Country

USA

Canada

Emergency Contact Name

Emergency Phone Number

Coach Year

Coach Model

Coach Floor Plan

Dues Paid By

Cell Phone Photo of Pilot & Co-PilotUpload a photo