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PT CRUISER
CLUB OF CENTRAL CALIFORNIA... Membership form
JUST CLICK FILE, PRINT AND SEND TO THE ADDRESS
BELOW!!
Do not type here on this form, print and fill in the form with a pen!!
The PT Cruiser Club of Central California meets the first Wednesday of the
month at Fresno Chrysler Plymouth at
7:00pm. Dues for new members are: $40.00 (includes
two
name badges and one logo for car) Dues for existing members are: $30.00
Dues are "Per
Car" and are due on the 1st of March every year. Each paid member will
receive a monthly
newsletter. Please make checks payable to PT Cruiser Club of Central Cal
and mail to:
PT Cruiser Club of
Central Cal
C/O Tom Highman
5125 W. Cromwell.
Fresno, Ca. 93722
Name_________________________________________________________________
Address_______________________________________________________________
City______________________________ State__________ Zip___________________
Home Phone
_______________Work phone ________________Cell______________
Current
E-mail_________________________________________________________________
First Names
preferred for name tags_____________________ __________________
Birthdays
______________________ _______________________
Anniversary ______________ Children ________ Pets__________
Hobbies___________ Discription of Car____________________________________
What would you like to
get from the club _________________
Any Changes to the above
information since last year? Yes______ No______
If yes, please circle the following changes: Address, Home Phone, Cell
Phone, Work Phone, E-Mail Address
NOTE; If you don't have an e-mail address what telephone # is the best to
call you on to remind you of
upcoming runs etc? Phone#____________________
Amount paid
$___________________________ Check Number____________________
PT
CRUISER CLUB OF CENTRAL CALIFORNIA WAIVER OF LIABILITY
Waiver: In consideration of participation in any activity of the PT
CRUISER CLUB OF CENTRAL CALIFORNIA hereinafter called:"THE ACTIVITY," I
for myself, my heirs, personal representative or assigns do hereby
release waiver, discharge, and covenant not to sue THE PT CRUISER CLUB
OF CENTRAL CALIFORNIA,
it's officers, employees, and agents from liability from any and all
claims including the negligence of
The PT Cruiser Club of Central California, it's officers, employees and
agents, resulting in personal injury, accident or illness (including
death), and property loss arising from, but not limited to, participation
in
The Activity. Each member shall carry the minimum insurance required by
the State of
California.
Signature of Member ________________________Date__________________
Signature of Member _______________________Date___________________
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