New _____________or   Renewal ____________                     Member # _______________

NAME: ______________________________________________________

SPOUSE:_____________________________   Email: _____________________________

ADDRESS: ____________________________________________________

CITY: ____________________________________ STATE: _______ ZIP:_________

PHONE: _________________ CELL PHONE: _____________________

Chevelles and /or El Caminos owned: ________________________________________________________

_______________________________________________________________________________________

SIGNATURE: ________________________________________________

DATE:____________________