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Print out this form and mail !!! (See below for Address) CLICK HERE FOR A .pdf FILE Mid-State Antique Auto ClubMembership
Application NAME:_______________________________________SPOUSE:____________________ ADDRESS_________________________________________________________________ CITY_____________________________________
STATE__________ ZIP___________ PHONE
(______) ______-___________________
E-mail__________________________ Do
you own an Antique/Classic Car? (Not a requirement)
Yes _____ No
_____ Recommended
by ___________________________________________________________ Please LIST THE YEAR, MAKE AND OTHER INFO FOR ALL YOUR ANTIQUE AND CLASSIC CARS (Please use a separate piece of paper for more than 2
cars) Year
Make
Model
Body Type & Antique/Classic/Custom/Rod 1 - _____
___________ ________
__________________________________________ 2 - _____
___________ ________
__________________________________________ I AM WILLING TO
HELP THE CLUB: (Please check) q
MEETS q
SOCIAL ACTIVITIES q
ADVERTISING q
PROGRAMS q
NEWSLETTER q
MEMBERSHIP q
OTHER IDEAS A membership fee must accompany this Application. Calendar year dues are included in this membership fee. 2005
Membership fee as follows:
$20 - Family membership
I
understand that membership in the MID STATE ANTIQUE AUTO CLUB
carries with it certain responsibilities.
Among these, is a willingness and desire to participate fully
insofar as I am able, in the Club's activities, functions and
projects. By my
signature below, I acknowledge my active support of the goals and
purposes of the MID STATE ANTIQUE AUTO CLUB, as stated therein. Signature
___________________________________
Date _____________ Received
_____________________
Treasurer _________________________ Accepted
____________________________________ for the Executive
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