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, there after dues will be $20 per year due in April.

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Updated October, 2007