Jan 17, 2019
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Please provide the information below for your club membership.  After submitting the form, you will be provided a link to our online club store to pay the one-time $40 membership fee via PayPal.  You do not have to create a PayPal account to pay by credit card.  You may simply pay as a guest.  When we receive notice of this form and payment confirmation a member of the board of directors will register your membership.  With registration you will be sent a welcome e-mail that will include your log in and password.
 

NOTE:  The items marked with an asterisk * are required entries.


Your Name *:
Street Address *:
City, State and Zipcode *:
Home Phone:
Mobile Phone:
Your E-mail Address *:
Refered by (Name, web, other):
Co-Pilot Name:
Co-Pilot Street Address:
Co-Pilot City, State and Zipcode:
Co-Pilot Phone:
Co-Pilot E-mail Address (See help info):  Help/More Info
Car(s) Year/Model/Color:
Areas of Interest:
Monthly Dining Out
Short Cruises
Day Cruises
Long Weekend Cruises
For Guys Only Events
For Girls Only Events
Fundraising Events, I will help in following areas:
Planning
Solicitation
Chairing Committee
Organize workers
Public Relations
Work day of event
Work wherever needed
Agree to release of any photographs taken of either myself or my car *:
Agree to release of any photographs taken of either myself or my car
Agree that my information may be published in the directory
Agree that my information may be published in the directory *:
Comments:

 

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