Membership Application

Meetings are held on the second Tuesday of each month at Husker Bar
2313 11th Street Columbus, NE 68601

Membership fees: $20.00 per full year. Couple: $30.00

Name _____________________________________________ Spouse______________

Home Address___________________________________________________________

City__________________ State____ Zip__________ Home Phone________________

Email address____________________________________________________________

Employer/Type of Business_________________________________________________

Name of Children: 

1. _____________________________________  
    
2. _____________________________________  
    
3. _____________________________________  
    
4. _____________________________________   
    

Club Car(s):
(1)        Year ________________ Make/Model ____________________________________________
(2)        Year ________________ Make/Model ____________________________________________
(3)        Year ________________ Make/Model ____________________________________________

Which Club Activities Would you like to Help Organize?   
Car Shows ________  Cruises ________ Show/Shine ________  Officer _________
Photographer _______  Newsletter _________ Other ___________

What kind of Auto Events Do You Enjoy? Drag Racing_____ Rallying_____
Auto Crossing______ Popular Vote Shows_____ Judged Shows ______

Dated:___________________ Signed:________________________________________

Please Return Membership Form and Dues To:
Platte Valley Mustang Car Club:
C/O Diane Gehring - Treasurer
2033 37th Street
Columbus, NE 689601

Make all checks payable to: Platte Valley Mustang Car Club