| Name: |
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| Significant Other's Name: |
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| Address: |
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| City: State: Zip: |
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Home Phone:
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Work Phone:
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Fax:
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Cell Phone:
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| Email Address (important!):
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Other Car Club Affiliations:
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| Vehicle Inventory
(Optional): Please indicate condition: A) Drivable; B) Project; C) Parts Car |
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| Please indicate
areas you would like to offer active assistance in club functions. |
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| Annual dues are
$20.00, and are due July 1st of each year. If you join after January 1st,
dues are $10.00. Please make checks payable to MMSCC. Please send check
to MMSCC, 41 Samoset Rd, Rockland Maine. 04841. You may use this online
form, or print it and mail with your check. |
