Application for membership
Date____________________
Name_______________________________D.O.B.- Mo.________Day________
Partner______________________________D.O.B.- Mo.________Day________
Mailing Address_____________________________________________
__________________________________________________________
E mail address_________________________________
_____________________________________________________________
Home phone___________________Work phone___________________
How did you find the club?_________________________________________________
Car year___________ color___________________
FIND OUT MORE ABOUT US AT OUR WEB SITE -
www.bigapplemiata.org
The information on this application is for club use and will not be provided for any outside mailing list without your written consent. Membership begins when completed application and your check or money order for $30.00 (including license frame). Annual dues are $25.00 per year payable annually on March 1st. Make checks payable to: Big Apple Miata Club
I agree that the Big Apple Miata Club or board of officers are not responsible for any damages or injuries that occur at any meeting or event of the club by a member or non member present. The individual, member or non member is solely responsible for his/her damage or injury.
Signature_________________________________________________
Mail to:
Big Apple Miata Club
780 South 6th St.
Lindenhurst,NY 11757