BUCKEYE MIATA
CLUB
MEMBERSHIP FORM
Date:
Name(s):
Address, including City,State, and
Zip Code:
Phone: (___)
E-Mail Address:
Name(s) as they are to appear on
name-tags:
__________________________________
__________________________________
Car Color and Year:
License Plate:
Type Of Membership:
[ ] Family $30.00
[ ] Single $20.00
New Member: ___
Renewal: ___
Please print this form and write a check payable to Buckeye Miata Club. Mail the completed form and check to:
Mike and
Brenda Fisher
