CASCADE COBRAS

www.cascadecobras.com

 

MEMBERSHIP APPLICATION FORM

 

DATE: _____________                    [   ] NEW MEMBER                             [   ] RENEWAL

 

NAME: ________________________________________ BIRTHDAY: (year optional) _________________________________

ADDRESS:______________________________________ CITY/STATE/ZIP:_____________________________

 

HOME PHONE: __________________________________ MOBILE PHONE (for runs):____________________________

 

E-MAIL ADDRESS: __________________________________________________________________________

 

SPOUSE Including Birthday, (year optional): ____________________________________________________________________

 

CHILDREN Including Birthdays: ________________________________________________________________

 

Do you wish the Cascade Cobras NOT to publish the above information in our club directory (available to club members only)?  [   ]

 

Car Project: Make _______________ Body Style ____________

Engine _________________ Suspension: ________________

Color: ______________________________

Completion Status: ____________________

Understand Purpose of Club:

The general purpose of the Club shall be to encourage replica ownership, operation and enjoyment of replica 1965 427 S/C automobiles (and their derivatives); provide service to others, and to encourage careful and skillful driving on public roads.

 

Signed: _____________________________ Date: __________________

 

 

THINGS WOULD LIKE TO DO/WORK ON:          

[   ] RACING/COMPETITION           

[   ] NEWSLETTER                             

[   ] CAR SHOWS                

[   ] RALLIES                                      

[   ] TOURING                                      

[   ] SOCIAL                                         

[   ] OTHER (Specify)________________________________

 

CURRENT ANNUAL MEMBERSHIP DUES ARE $35.00.   

 

MAKE CHECK PAYABLE TO:

 

CASCADE COBRAS

P.O. Box 2893

Wilsonville, OR 97070-2893