___________________________________________________________________________________________
Revised August 2014
National Park Travelers Club
New Membership & Renewal Form
* MEMBER NAME: FIRST: ______________________ LAST: ______________________________
JOINT MEMBER (if applicable): FIRST: ______________________ LAST: ______________________________
MEMBER BIRTHDATE: _____________ JOINT MEMBER BIRTHDATE (if applicable): _________________
The Following Fields are REQUIRED for JR MEMBERS ONLY (under 18 yrs old):
* Full Date of Birth INCLUDING YEAR: _____________________________________________________
* Sponsoring NPTC Member or Parent/Guardian Name: _________________________________________
* Sponsoring NPTC Member or Parent/Guardian Signature: ______________________________________
* ADDRESS: _____________________________________________________________________________________
* CITY: ____________________________________ * STATE: ________________ * ZIP CODE: _________________
EMAIL: _________________________________________________________________________________________
I would like to receive periodic emails from the NPTC, including the NPTC Newsletter, “The Stamp Pad”: _____ YES _____ NO
>>>>>NOTE: The NPTC will never sell or share email or postal addresses for non-NPTC business!<<<<
* NPTC Website (www.parkstamps.org
) USER NAME (Logon ID or Display Name): ____________________________________
NUMBER OF NPS UNITS VISITED IN LIFETIME TO DATE, IF KNOWN (no stamp required): ___________________________
* = REQUIRED FIELD
Membership Designations:
NOTE: All Memberships are for one year and expire 12 months from the month you join.
- Applicants may pay for multiple years at once; for example, 3 yrs for a new member = $10 + 2x$5 = $20
- NPTC policy does not allow dues refunds, even for dues paid in advance.
____ NEW Individual Membership ……………………………………………………………………………… $10.00 / 1
st
year only
____ NEW Joint Membership (only 1 card will be issued) ……………………………………………………… $10.00 / 1
st
year only
____ NEW Junior Membership (under 18 years old) ……………………………………………………….……. $ 5.00 / 1
st
year only
____ RENEWAL Membership for ALL types …………………………………………$5.00 / yr x _____ yrs = $ _______________
TOTAL AMOUNT ENCLOSED: $ _______________
How did you hear about the NPTC? _________________________________________________________________
RECRUITED BY (NPTC Member Name &/or Number): __________________________________________________
Make Checks or Money Orders payable to the National Park Travelers Club
****DO NOT SEND CASH****
Mail Completed Form & Dues to:
Pat Hierl
NPTC Membership Director
PO Box 4869
Whitefish, MT 59937
Date Received: _____________
Renewal Date: _____________
Date Card Sent: ____________
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