Membership Application
Name_____________________________________ Date of
Birth__________________________________
Spouse’s
Name_____________________________
Spouse’s Date of Birth__________________________
Address___________________________________ Anniversary
Date______________________________
City/Town_________________________________ State/Province_______________ Zip code_________
E-Mail Address_____________________________ (Add additional family members and birthday on back)
I own the following vehicle(s)
|
YEAR |
MAKE |
MODEL |
BODY TYPE |
CONDITION |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
NOTE: IT IS NOT NECESSARY TO OWN A VEHICLE TO JOIN THE CLUB!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Annual Dues: $15.00 Membership covers calendar year Jan. 1st to Dec. 31st Fees are due by Feb.1st.
Please make checks or money orders payable to Massena Olde Car Club
Inc. Mail with completed
membership form to Massena Olde Car Club Inc
Visit us on the web at http://mocc.freeservers.com or E-MAIL us mocc@mail.com
Are you willing to work on committees for Club function ( ) Yes ( ) No
Membership meeting are held on
the first Monday of the Month at
Signature of Applicant____________________________________________ Date______________________
THIS SECTION FOR OFFICE USE ONLY
Date payment received_____________________________Cash_______Check#_______Money
Order____
Amount received $_____________________Membership
paid thru:______________________________
Temporary Card issued_______________________Membership card
mailed_______________________