OREGON REGION

of the
CLASSIC CAR CLUB OF AMERICA

Membership Renewal – 2010

Annual membership dues:                      $ 35.00
Annual associate dues:                             $ 5.00
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

Membership in the National CCCA is required for membership in the Oregon Region.  Please contact me if you do not have a National form.

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.