Please print out this form, fill it in and send to us at the following address:
Name: __________________________________________________
Address: ________________________________________________
City: ____________________________________________________
State: _______________________ Zip: ________________________
Phone: __________________________________________________
Business Name: ___________________________________________
Membership Plan: _________________________________________
Dates: _______________________ to _________________________
Motel: ___________________________________________________
Number in Party: __________________________________________
Signature: ________________________________________________
Date Signed: ______________________________________________
Owners: Glenn D. & Barb Neideigh
12726 Highway F70 West . Runnells, IA 50237
(515) 966-2095
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