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Horseless Carriage Club of America |
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THE BLUEGRASS REGION ofTHE HORSELESS CARRIAGE CLUB OF AMERICA APPLICATION FOR MEMBERSHIP (please print) Date of Application ___________________ HCCA Number _____________________ Name _____________________________Spouse's name________________________ Address _____________________________ City_________________________________ State _______ ZIP _______ Email _______________ Home phone ____________ Work phone ___________ List of antique automobiles you own (optional) Year ____ Make ____________ No. of cylinders ____ H.P. ____ Body type__________ Year ____ Make ____________ No. of cylinders ____ H.P. ____ Body type__________ Year ____ Make ____________ No. of cylinders ____ H.P. ____ Body type__________ Annual membership dues per family: $5.00 Please return this form to any
officer or by mail with your check payable to Bluegrass Region HCCA. |
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Last modified: 05/13/07.
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