2135 S. Hanna Street Fort Wayne, IN 46803
Phone: (260) 456-1802
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Fax: (260) 456-8880
Membership Application
Membership Eligibility:
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First Name
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DL State of Issue
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This is a secure application but if you are uncomfortable providing your SSN here you may call us with this info after submission. We cannot process your application without this information.
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Is there a joint applicant?
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Joint Applicant Information
First Name
Middle Initial
Last Name
Date of Birth
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Email Address
Phone Number
Driver's License #
DL State of Issue
Social Security #
This is a secure application but if you are uncomfortable providing your SSN here you may call us with this info after submission. We cannot process your application without this information.
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