2008 Tidewater Mopar Club Application
Please fill in the following information to help us keep our records are current;only things in bold are required!
Personal
Information:
Name(ex.
Johnny Mopar)
_______________________________________________________
mailing address (where to send the newsletter):
Street
1(ex. Apt. 727A)
______________________________________________________
Street
2(ex. 440 Easy St.)
______________________________________________________
City
(ex. Hampton) ___________________
State (ex.
VA) _______
Zip (ex.
23607)________
Home Phone (ex. (123)456-7890) ___________________________________________
Cell
Phone ______________________ Work
Phone __________________________
Email
(ex. fast@tidewatermoparclub.com)
__________________________________________
alternate
Email (if primary doesn't work)
___________________________________________
Do
you wish to receive weekly Emails from TMC? ___ (Yes or No)
Do you want to be notified of last minute changes (rained out shows, etc.)?
Email?__ cell?__ home? __ work? __
Information
About You & Your Vehicles - entirely optional
Spouse
(ex. Mandy Mopar)
_________________________________________________
Your
birthday (ex: 3/22)___/___
pouse birthday (ex.
mm/dd) ___/___
Anniversary ___/___
Occupation
(ex. machinist)
__________________________________________________
Please
list your favorite personal vehicle:
(YEAR
MAKE MODEL COLOR CONDITION ENGINE etc.) (ex:
1968 Dart 225ci /6 bone
stock)____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Comments
or suggestions?
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Club dues are $20.00 a year. All memberships expire on December 31st of each year and club dues will be due starting January 1st of each year. The dues primarily cover newsletter postage & printing costs. Please let us know if you move or change Email or phone numbers so we can keep you informed.
Please make your check payable to "Tidewater Mopar Club" and either bring it with you to a meeting or mail it to the TMC:
Tidewater Mopar Club
P.O.Box 694
Newport News, 23607