OREGON REGION

of the
CLASSIC CAR CLUB OF AMERICA

Membership Renewal – 2011

Annual membership dues:                      $ 40.00
Optional Oregon Region name tag  $ 7.00 each

Names for name tags __________________________________________________
                                    __________________________________________________

Here is my check for $________ for my 2010 membership dues and name tags in the Oregon Region.

 

NAME______________________________ASSOCIATE (Spouse)_______________
ADDRESS__________________________________CITY _____________________
STATE___________________ZIP___________

HOME PHONE____________________   CELL_____________________________
WORK PHONE____________________   EMAIL____________________________

Additions or deletions from the 2009 roster to your Full Classics stable

MAKE                  YR    CYL   MODEL                    BODY STYLE                  ADD/DEL

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

Please print and fill out this form, make check payable to:  Oregon Region CCCA

Mail form and check to:

Bob Earls

Membership Chairman

14104 SE Oatfield Rd.

   Milwaukie, OR 97267

 Please Note:

Membership in the National CCCA is required for membership in the Oregon Region. 

You can join the National CCCA on line or print out the form at:    http://classiccarclub.org/join_us/member_benefits.html

The National form and dues should be mailed direct to:

Classic Car Club of America

1645 Des Plaines River Road #7

Des Plaines, IL 60018

If you have any questions, please call (503) 786-1606 or email me at: corvairdude@comcast.net

Club year beings November 1.  All amounts payable in US funds.