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CLASSIC CAR CLUB OF AMERICA--NORTHERN CALIFORNIA REGION MEMBERSHIP APPLICATION (NEW OR RENEWAL) For renewals, please check ( ) box if there are no changes to your current listing in the directory.Name: ________________________________________________________________ Spouse: ________________________________________ Address:_______________________________________________________________ Phone No. (H): __________________________________ City: _________________________________ State:_________Zip: _______________ Phone No. (W): __________________________________ E-mail: ________________________________________________________________ FAX: __________________________________________ I am a member of National CCCA (Required) Yes ____________________________ or (Re) Joining ___________________________________ I carry liability insurance for any vehicle(s) I bring to CCCA events _______________________________________________________ (required). Date: __________________________ Signature: ______________________________________________________________________________ ADDITIONS TO CURRENT LISTING: (List only those cars approved by the Classic
Car Club of America) ______________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________ DELETIONS TO CURRENT LISTING: ______________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________ Annual dues are $25.00 per year. To apply, print and fill out this form. Include a check payable to "CCCA NorCal" and mail to: Bob Babineau, 8450 Santa Cruz Road, Atascadero CA 93422 |
Last modified: December 22, 2005 |