Application for Membership​

(Print or Download)

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Pilot _____________________________  Copilot_______________________

 

Address      Street ___________________________________

 

                   City ____________________________ State _____ Zip _________

 

Secondary Address  ____________________________  FRVA # _____________

 

Primary Phone ______________________________ (Home ___ Cell ___)

 

Email ____________________________________  Alt Phone ________________

 

New members pay $30 per coach, which covers a one-time initiation fee,                    name badges, documents and membership list. The next year an annual                      membership fee of $20 will be due the following October 1.  Our fiscal year is 

  October 1 to September 30.

 

  Please make your check out to:  Pikes Peak Rollers

  Send your application and check to the club president:  

  Darryl Barker, 7713 Red Rock Cir, Larkspur CO 80118

 

Signed: ____________________________________  Date: ________________

 

RV Information:  Class  A  /  B  /  C   /   trailer  /  5th Wheel  

                           Manufacturer _______________________  Length _________

                           Gas ______  Diesel ______  N/A ______  Slideouts _______

 

Important Months:    Birthday      Pilot ______________ Copilot _____________

                                 Anniversary  ________

 

Name badges:  Please print below exactly how your badge is to read

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Pilot: _________________________  Copilot: ______________________

 

        Revised 6/5/25