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Membership Application

To become a member, please fill in the information on this page and then print it.  Ownership of a professional car is not required for membership.   Remember, membership in the The Professional Car Society is a prerequisite to membership in any of it's chapters.
Name
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Telephone
E-mail
Car(s) Owned
List year
Body Mfr.
Chassis Mfr.
Body Style
Membership Dues
(Select one)		 One year $15.00
Two years $25.00

Select "Print" on your browser to print out form when completed

Pleas make checks payable to: JON WURM, TREASURER

Mail payments to:
Jon Wurm, Secretary / Treasurer
6709 Greenway Lane
Forest Lake, MN 55025

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