Please print this form and mail to the address shown on the form!
| Member____#______________
Member___#________________ Paid_______________#______ Paid_______________#_______ Date____________Exp_______ Date____________Exp_______ |
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Single |
Dual |
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| For
Membership Directors use only ========================================= |
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FROM THE
CLASSICS, ANTIQUES AND MUSCLE CARS TO |
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| Our purpose is to promote the preservation and restoration of motor vehicles produced by the Chrysler Corporation and to provide a common meeting place for the membership to accomplish the purposes of the organization and promote goodwill among themselves and their sport. | ||
MEMBERSHIP/RENEWAL FORM |
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| Date
__________________________ New
Renewal Name _________________________________________ Address _______________________________________ City __________________________________________ Occupation ____________________________________ E-mail address _________________________________ |
How long have you been a member?
________ Age _____________ Phone________________________ State _____ Zip ________________ |
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| Make and Model of car(s)
_______________________________________________________________________ Other special-interest autos owned (non-mopar) ______________________________________________________ Would you be interested in having your name and phone number published in a club directory? Yes No Would you be interested in a Staff or Committee job? Yes No What special skills do you have that might benefit the club? _____________________________________________ Do you have any suggestions as to the type of activities in which you would like to see the club participate?________ ___________________________________________________________________________________________ Any other suggestions or comments? ______________________________________________________________ ___________________________________________________________________________________________ What or who encouraged you to join Seattle MoPars Unlimited? __________________________________________ If you are under the age of 18, for club insurance purposes, we must obtain your parental or legal guardian's signature prior to acceptance of membership with the Seattle MoPars Unlimited. Parental or legal guardian signature _________________________________________________ |
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Please return completed form and membership dues to: Make checks payable to "MoPars Unlimited" |
MoPars Unlimited Membership Director PO Box 615 Lynnwood, WA 98046 |
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| Membership rates (according to month of registration) | |
| If you join in the month of: | Then you owe |
| Jan-Feb-Mar-Apr-May June-July-Aug-Sept Oct-Nov-Dec Add and additional $5 for dual membership (spouse) |
$25.00 $22.00 $31.00 |
| Membership entitles you to
the following: Membership plaque, membership card, club window decal (new members only),
monthly newsletter (free ads), and parts discounts at participating dealers/businesses. MoPars Unlimited, Seattle Chapter, meets the last last Tuesday of each month at Alfy's Pizza at 4820 196th SW in Lynnwood. Meetings start at 7:30 pm and run approximately one and a half hour. |
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