Application for Membership

Dues $20.00 per year due in April

Car Nuts Car Club, Inc.

P. O. Box 1126

Marion, VA 24354

Name: ________________________________________________________________________

Spouse or S/O: ________________________________________________________________

Address: ______________________________________________________________________

City, State, Zip: _______________________________________________________________

E-mail Address: ________________________________________________________________

Home phone #: ________________________ Work or Other #__________________________

Car Make: ________________________ Year: _______________ (Attach picture if available)

Model:_____________________________

Engine: ____________________________

Transmission: _______________________

Other vehicles: ________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

Pro-rated Dues:

Pro-rated dues: Join in April - Sept. dues are $20, Oct. - March, dues are $10.00 pro rate will be for new membership only, thereafter dues will be $20 per year due in April.