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

R-Rides
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 2009   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: ___________________________________________________________________________



SHOW CARS OWNED

YEAR:_____________MAKE:_________________________MODEL:__________________________________

YEAR:_____________MAKE:_________________________MODEL:__________________________________

YEAR:_____________MAKE:_________________________MODEL:__________________________________

YEAR:_____________MAKE:_________________________MODEL:__________________________________

Make checks payable to: NORTHERN INDIANA CRUISERS

MAIL APPLICATION TO:
JoAnne Dodrill / Secretary
1000 Beech St.
Valparaiso, Indiana 46383

© 2009 R-Rides Northern Indiana Cruisers Motor Club. All rights reserved. 
All trademarks and logos are the property of R-Rides.