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MASSENA OLDE CAR CLUB Inc

PO Box 465

Massena,NY 13662

 

APPLICATION FOR MEMBERSHIP

Name___________________________________Occupation___________________________

Address_________________________________City/Town____________________________

State/Province____________________________Zip/Postal Code________________________

Telephone: Home____________________________Office__________________________

E-Mail _____________________________

 I own the following antique and/or classic car(s):

Condition of Automobile Code

  A - Restored     D - Rough but Restorable
  B - Complete and good or nearly restored      E - Parts car
  C - In Process of Restoration            F - Under Construction

                                                                              Automobile Info

                                                

YEAR

MAKE

CYL.

MODEL

SERIAL NO.

ENGINE NO.

BODY TYPE

CONDITION

               
               
               
               
               

I (CARRY) (DO NOT CARRY) adequate limits of Public Liability and Property Damage Insurance on my car(s).

Are you willing to work on committes for club functions?  (yes)         (no)

 

Signature of Applicant_____________________________________Date_____________________________

 

NOTE: IT IS NOT NECESSARY TO OWN A CAR TO JOIN THE CLUB!!

 

Annual Dues = $10.00

Membership covers calendar

year Jan. 1st to Jan. 1st

Fees are due March 1st

 

Visit us on the net at http://mocc.freeservers.com/index.html

or

http://members.tripod.com/dakota94/index.html

 

You can also down load the Application File at our Download Site

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