Membership Application
NAME_____________________________________
ADDRESS_________________________________
CITY STATE________________________________
ZIP_________
HOME PHONE ( ___)_____-_______
WORK PHONE (___ )_____-_______
(OPTIONAL)EMAIL ID _________________@__________________ *
__ Yes, I want to subscribe to the monthly club newsletter and donate $6 for a 1-year subscription. I am including payment. (checks made payable to Herschel Dalton)
Do you own a VW? ____
YEAR _______ MODEL __________________________ COLOR _________
YEAR _______ MODEL __________________________ COLOR _________
YEAR _______ MODEL __________________________ COLOR _________
YEAR _______ MODEL __________________________ COLOR _________
How did you hear about our club?____________________________________
______________________________________________________________
______________________________________________________________
*
Email is frequently used to communicate within the club.______________________________________________
______________Signature Date
Bring this form to the next Club Meeting or mail to:
HERSCHEL DALTON
MID-SOUTH VOLKSWAGEN CLUB
2999 WALNUT GROVE RD., APT. 2
MEMPHIS, TN 38111