Name:_____________________________________________________________
Spouse:____________________________________________________________
Children:___________________________________________________________
Address:___________________________________________________________
City:_______________________________
State:_______ Zip:_______________
Home phone:________________________
Work phone:____________________
E-mail
address:_____________________________________________________
Vehicles/Condition:
Vehicle
|
Condition
|
Type
|
Year
|
Color
|
Original
|
Restoration
|
Show Quality
|
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What are your interests (check one):
Autocross |
Drags |
Car shows |
Social Events |
Rallies (non speed) |
Parts Swap |
Tech Seminars |
. |
. |
. |
. |
. |
. |
. |
Other:_________________________________________________________
Willing to help with club activities
(check one):
Newsletter |
Mailings |
Planning/Organizing Events |
Working at Events |
. |
. |
. |
. |
Other:_________________________________________________________