All new memberships must be submitted on this form.  You may make as many copies as you need. Fill in
CHAPTER name at top of form.

Be sure that you have given all info -- last name, both first names, street address, city, state, complete zip,
telephone number, e-mail address, Good Sam number, expiration.

Make check out to Good Sams of Florida, Inc.  Mail 2 copies of form plus check to
State Director WILLIAM MAXWELL                                    
601 PINEDALE COURT                                        
BRANDON, FL 33511                                        
PHONE # (813) 689-9607                                        
CELL # (813) 245-7870  

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