NEW CLUB MEMBERSHIP

MCLV MEMBERSHIP FORM
Single Membership=$24.00/Yr Family Membership=$32.00/Yr

Name:

Date of Birth:

Address:

City:

State:

Zip:

Phone:

E-Mail Address:

VEHICLE INFORMATION

Year:

Body Style:

Color:

Year:

Body Style:

Color:

If this is a family membership please fill in the following information

Spouse:

Date of Birth:

CoMember1:

Date of Birth:

CoMember2:

Date of Birth:

SELECT PAYMENT TYPE

PayPal/Credit Card

Check/Cash