New Member Application Form

Fill out form, be sure you agree to terms, enter code and click "Submit Form" button. After submitting, you will be directed to payment options. Thank you for joining.

* Required fields
Name *
E-mail Address *
Confirm Email *
Date *
Street Address *
City *
State *
Zip Code (9 digit) *
Phone number is *
Phone: *
Year/Model (1961 B)
Body Style (Coupe, etc.)
Engine Type (1600S)
Comments/History on any of the cars:
Areas of Interest/Expertise
I can help the club with:
In addition to the email version of FOGLight, would you like to receive the printed version?
How will you be submitting payment? *
Do you want your email address published in our Membership Directory? The list is not posted on our website and the emailed version is converted to a format that cannot be hacked. *

Please enter the code shown above and click the 'Submit Form' button. This additional step is required to help protect against message spam.