Emergency Information for your membership card (extra charge $1.50)

Emergency Info next of kin, name: next of kin contact info: allergies: medications: doctors name and contact info:

Membership requirement: To become a member of Loners on Wheels, you must be legally single. Clicking continue to send this form is a testament to that fact. If you should marry while being a member, your membership is automatically terminated. If you, (man or woman, not blood related), arrive or attend an official LoW event (one that has been announced in the Newsletter) in the same rig, your membership will be automatically terminated. Clicking continue to send this form indicates permission to publish your information in our annual directory. If you wish to withhold any of the above information, please leave that part empty. In clicking the 'Continue" button I further agree that the LoW directory is to remain confidental and that I will never use it, or knowingly allow it to be used, for other than my personal use.