Z Club of Texas Sign-up Form

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Z CLUB OF TEXAS Membership #_____________________
P.O. Box 832948
Richardson, Texas 75083 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 _____________