To print this application go to file, print. Then mail to the address below.

Northern Indiana Cruisers
Membership Application
(Please print or type)

NAME:______________________________________________________SPOUSE:_____________________________________
Last First M.I.

ADDRESS:_____________________________________________________CITY:_______________________________________

STATE:_______________ZIP:___________-_______ PHONE NO.____________-___________________


MONTH & DAY OF BIRTH:_______/_______ MEMBERSHIP YEAR 2005   NEW:_____ RENEWAL:______

EMAIL ADDRESS __________________________________________-

FEE: $25
NOTE: ALL MEMBERSHIPS EXPIRE ON JANUARY 31st.
MEMBERSHIPS NOT RENEWED BY MARCH 1ST EACH YEAR WILL NOT RECEIVE THE NEWSLETTER.

How did you hear about our
club?________________________________________________________________________________________________


DATE: APPLICANTS SIGNATURE: .



CLASSIC CARS OWNED

YEAR:_____________MAKE:_________________________MODEL:__________________________________

YEAR:_____________MAKE:_________________________MODEL:__________________________________

YEAR:_____________MAKE:_________________________MODEL:__________________________________

YEAR:_____________MAKE:_________________________MODEL:__________________________________

Make checks payable to: NORTHERN INDIANA CRUISERS

MAIL APPLICATION TO:
Barb Rittel
Secretary

357 W. Division Rd.

Valparaiso, Indiana 46383

© 2000 R-Rides Northern Indiana Cruisers Motor Club. All rights reserved. 
All trademarks and logos are the property of R-Rides.