Membership Application

Email Address: *

How did you hear about NMvanpools ?: *

Applicant’s Name: *

Work Phone: *

Home Phone: *

Home Address: *

City: *

State: *

Zip: *

Employer: *

Major cross streets closest to work: *

(E/W)

(N/S)

I work in the: *

building.

Rider Status: *

Full-time Stand-by Temporary / Seasonal

Scheduled Work Hours: *

a.m.

p.m.

Date of Birth: *

Van Number:*

* - fields are Mandatory

I understand and agree that by applying for membership with NMvanpools, I must abide by the By-laws, Policies and Procedures, and Code of Conduct of said organization. I understand that I am responsible for promptly advising the NMvanpools office of any illegal or unsafe situations occurring on an NMvanpools van.

I Agree.

(505) 414-3473 (phone) | (505) 771-2812 (fax) | info@nmvanpools.org