2010 Membership Application
Lakers Car Club
2010 Membership Application
Lakers Car Club
| 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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