SOUTHERN COLORADO MOPARS,INC

SOUTHERN COLORADO MOPARS, INC.®
P.O. Box 15254
Colorado Springs, Colorado 80935-5254

Membership Application for 2008
New_______ Renewal______

PLEASE PRINT

NAME:_____________________________________________________________ DATE:_______________

ADDRESS:_____________________________________________ CITY:____________________________

STATE:_______________________________ ZIP CODE:______________________

HOME PHONE:______________________________ WORK PHONE:_________________________________

VEHICLES:

MAKE:_____________________ MODEL:___________________________________ YEAR:__________

If possible please submit photo(s) of your vehicle(s) for the club photo album.

If you have electronic mail please include your e-mail address:

_________________________________________________________________________________________________

Please check here is you want to receive the monthly newsletter via e-mail: _____ Do you wish to subscribe to the Southern Colorado Mopars Online General Discussion List:_____

Your name and phone number (no addresses) are printed periodically in the SCM Club Roster. Please check here if you do not want your number included in the phone list: ____

Annual dues are $25.00 per year. The SCM membership year runs from January 1 - December 31. New members joining after January will have dues pro-rated at $1.00 per month. Please make checks payable to Southern Colorado Mopars, INC.® Payment may be made in person or mailed along with this application to the club address above. Immediate family members living in above household are included as SCM members at no extra cost.

Please list family members you wish to include in the SCM roster.

NAMES: _______________________ _________________________ ________________________

_______________________ _________________________ ________________________

Please indicate the number of additional membership cards required for any family members mentioned above ______. Card is required for anyone over the age of 16 wishing to receive discounts on parts or services.

Please read and sign back page before submitting application.

SOUTHERN COLORADO MOPARS, INC.® is an incorporated, non-profit organization existing for the enjoyment and assistance of its members. Upon receipt of dues and application, you will receive a SCM membership card, which can be used for discounts at local shops. A copy of the SCM bylaws and current discount list is available from the club secretary if needed. In addition you will begin receiving the monthly newsletter.

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I have read the above and understand its content. I in no way hold SOUTHERN COLORADO MOPARS, INC.® liable for any accident or physical harm.

SIGNATURE:_______________________________________________________ DATE:_____________________

Please return this form to any SCM board member or mail to the mailing address at the top of the form. This will ensure your name is added to the mailing list, as well as to the official roster.