Date ________________

Name ____________________________________________________________

Address __________________________________________________________

Phone # _____________________ Spouse's Name ______________________

I support the purposes of The Central 0regon 0ld Car Club, which are to encourage the preservation, maintenance and enjoyment of old and vintage automobiles, and to foster fellowship and communication among their owners. The membership dues are $15.00 per couple, at time of joining, plus the additional price of name tags, $6.00 per member. Dues are payable annually on the first of July each year. Meetings will be held the third Sunday in each month unless otherwise determined by a majority of membership. The time of the meetings will be 1:30 P.M. unless otherwise specified in the monthly newsletter.

I (we) hereby apply for membership in The Central 0regon 0ld Car Club.

Make of Car: Year: Model: Body Style: Color:

_________________ ___________ ___________ __________________

_________________ ___________ ___________ __________________

_________________ ___________ ___________ __________________

_________________ ___________ ___________ __________________

How did you hear about our club?

Please return to: The Central 0regon 0ld Car Club

P0 Box 281

Bend, 0R 97709