Lakers Car Club
Membership Application
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