Registration

Valley Cruisers Car Club

P.O. Box 1184, Gardnerville, NV 89410

Membership Renewal Form

Please complete this form and return with your $15 registration fee by January 31st to:

P.O. Box 1184, Gardnerville, NV 89410

Memberʼs Name:____________________Birthday_______________

Spouse_______________________Birthday___________________

Other family members in household:

Name____________________Relationship_________________B-day_______________

Mailing Address**______________________________________________________________

Residence Address ______________________________________________________________ _______________________________________________________________________________

City, State & Zip _______________________________________________________________

Home Phone:___________________________ Business ________________________________

Cell Phone ____________________________________________________________

EMAIL Address: _______________________________________________________________

**Please fill in Residence Address if different than mailing address

CLASSIC CARS CURRENTLY OWNED

YEAR MAKE MODEL COLOR _____________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________