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Text Box: Membership Application

Text Box: Inland Empire GTO Club New Member Application             Today's date:____________________   Name: _______________________________________________________________________ Spouse’s or Significant Other’s Name: _____________________________________________ Address: ______________________________________________________________________ City: _______________________________________     STATE: ________     ZIP: __________ Phones: Home: ____________________________         Work: _________________________________ Cell: _____________________________          Pager: _________________________________ E-mail Address: ________________________________________________________________ Dates: Birth date: _____________________           Spouse’s Birth Date: ___________________________ Anniversary Date: _______________________ Vehicles: Year:  ___________________    Make: __________________      Model: __________________ Year:  ___________________    Make: __________________      Model: __________________ Year:  ___________________    Make: __________________      Model: __________________ Year:  ___________________    Make: __________________      Model: __________________ Hobbies/Skills: ____________________________________________________ ____________________________________________________ What do you want from the club/preferred activities? ____________________________________________________ ____________________________________________________   This information is requested for club use only.  We would however, like to publish a roster in our newsletter periodically.   Please indicate if your information can be published with the others.              /_/   Publish telephone number  and email address with others                       /_/ Publish only names   All new members must submit an application for membership to the Club Treasurer.   Membership is reserved to those individuals who have an avid interest in Pontiacs, agree to abide by the bylaws of the club, and agree to conduct themselves in accordance with the family oriented nature of the club.  New members must submit with their application the annual club dues ($20.00).   Please print  and complete this application.  Mail the completed application to:  Inland Empire GTO Club New Member Application 10800 Lake View Road Yucaipa, CA 92399-2980