Z Club of Texas Sign-up Form

Z CLUB OF TEXAS                    Membership #_____________________
P.O. Box 2766
Grapevine, Texas 76099

Referred By:_____________________
   
Annual Dues:
Family $41.00
Self $36.00
Associate $25.00 (non-Z-Car owner)

*** PLEASE CLEARLY PRINT ALL INFORMATION - APPLICANT MUST BE AT LEAST 19 YEARS OLD ***            

   
Your Name ________________________________________ Your Birthday ___ / ___ / ___
   
Home Address ________________________________________ Home Phone (    ) _____-_________
   
City _______________________ST____ZIP_________ Spouse's Name _______________
   
E-mail ________________________________ Spouse's Birthday ___/___/___
   
Company Name _________________________________________ Work Phone (    )_____-______
   
Address _________________________________________ Occupation _______________________
   
City _______________________ST____ZIP_________ Spouse's ____________________
   
Car 1 Data: Color _______ Yr ____ Model ______ Serial # ________________ Lic.    # _______


Car 1 Data: Color _______ Yr ____ Model ______ Serial # ________________ Lic.    # _______


Car 1 Data: Color _______ Yr ____ Model ______ Serial # ________________ Lic.    # _______

   

I AM INTERESTED IN THE FOLLOWING AREAS WITHIN THE Z-CLUB: TECHNICAL INFO ___    CRUISE ___
   
SHOWING MY CAR __ AUTOCROSS __ RALLYING __ OTHER ______________________________________


Hobbies ________________/_______________/_______________/________________/_____________
   
            

			Signed __________________________________ Date ____________