Sunshine Chapter Application

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Printable PDF Copy  CLICK HERE

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 Date:__________ 

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Members Name: ____________________________________
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Spouses Name: ____________________________________
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Mailing Address: ___________________________________
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___________________________________
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Telephone #: ____________________ Cell Phone #: _______________
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Email Address: _____________________________________________
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National SMART Membership #: ________ Expiration Date ________
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Branch of Service: _____________________
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Referred By: ______________________________________
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Special Medical Needs or Concerns: ______________________________
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Members Birthday (Month/Day) ____________ Spouse: _______________
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Dues are $15.00 a year to be paid by March 1 . Payment of dues for new members are prorated for the second half of the year @ $1.25 per month. You must provide proof of membership in the National SMART organization (i.e. your membership number) before your chapter application may be submitted.
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Checks are payable to Florida Sunshine Chapter. Send to:
Bob Ewald

507 Fairways Drive
Titusville, FL 32780.

(321)385-0667
ewald32137@aol.com