Membership Application
Lakers Car Club         www.lakerscarclub.com

  Today's Date___________  Name___________________________________
Address_______________________________________________________
  City_______________________  State_____________  Zip______________
  Home Phone__________________  Business Phone________________
  Cell Phone_______________  E-Mail Address______________________
  Spouse Name to be listed with membership_____________________________
   
  Interesting Cars that you own:
  Year               Make                        Model                      Style                             
  _____________________________________________________________________
  _____________________________________________________________________
  _____________________________________________________________________
  _____________________________________________________________________
  _____________________________________________________________________
   
  Annual Dues are $20.00  for fiscal year from January through December.
  Make checks payable to:                     Lakers Car Club
  Mail application and check to:              Lakers Car Club 
                                                              C/O  Robert Smith
                                                              36104   Barbour Lane
                                                              Pine River, MN  56474
   
  Amount Paid______________  Check Number_____________
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