THE MG CAR CLUB OF CENTRAL NEW YORK
Please print this 1 page form and mail it with payment to the address at the
bottom
Annual Membership Dues are $20.00 -- All Memberships expire December 31st
Name__________________________________________ Birthday________________
Spouse_____________________ Friend_____________________________ Birthday____________
Phone: Home________________ Work_________________ Cell ____________________
Address_________________________________________________City__________________________
State__________ Zip+4_____________ Today’s Date____________ New or Renewal?___________
Cars Owned & Yr. _______________________________________________________________________
INTERESTS: Racing____________Gymkhana____________Rallye____________Restoration___________
Car Show_________Social_________Touring_________Other_____________________
Hobbies, etc.____________________________________________________________________________
Occupation_____________ e-mail Address_______________________ e-mail club newsletter Y or N ____
Roadside Help? No_______ Yes_______ Days_________Evenings______Nights_______Weekends______
MAIL APPLICATION WITH CHECK PAYABLE TO:
Mail
to: MG Car Club of CNY
Attn. Patty Golas
P.O. Box 1666
Cicero, NY 13039