MEMBERSHIP ENROLLMENT FORM

Just fill out, then print this form. Membership is $15.00 per year


Your Name:  Spouse's Name:

Anniversary:   Your Birthday:   Spouse's Birthday:

Address:

City:       State:     Zip:

Phone:     Email:

Forum Username 1st Choice:   2nd Choice:

Your PT Cruiser - Year:    Color:      Turbo: Yes No

List any changes you have made to your PT Cruiser:



I realize that activities for this club may involve some potential hazards. I agree that the Eights & Aces PT Cruisers and its coordinators shall not be held liable by me, my relatives, my heirs, legal guardian or representatives for any act that may result in my injury or death while freely participating in any activities sponsored or organized by the aforementioned organization.

 

Signature:____________________________________     Date:______________________

Check, Cashiers Check or Money Order made payable to:
John Jones

Mail to:
Eights & Aces PT Cruisers
4109 E. Ogden Ave.
Las Vegas, NV 89110