Cruisin’ Buddies Rod & Custom Car Club

                 MEMBERSHIP APPLICATION 
                           (See instructions at bottom) 

Name: (M) ______________________________________ Birth-Date ______________________

Name: (F) ______________________________________ Birth-Date ______________________

Address: _______________________________________ Anniversary ___________________

City: _________________________ State: _____________________ Zip: ___________________

Phone:(        )__________________Cell #:_____________________Listed:____Unlisted:____

E-Mail: ______________________________________________________________________

Vehicle Information:
Owner: ____________________Year: ________ Make: _____________Model:______________

Licensed: Yes___No___Plate #:____________Inspected: Yes___No___ Insured: Yes___No___

LIST ADDITIONAL VEHICLES ON BACK OF FORM

******************************************************************************************  
LIABILITY RELEASE:           
 I understand that Cruisin’ Buddies Rod & Custom Car Club, their officers, staff, management, representative, the sponsors, and the event charity are not responsible for loss or injury to me or my property.  I hereby expressly release same from any liability for such loss or injury.  I hereby agree to abide by the rules and regulations of the Cruisin’ Buddies Rod & Custom Car Cub, and remember our actions reflect on our club’s reputation.

CAR PHOTO RELEASE:
I release any or all photos of my automobile to Cruisin Buddies Rod & Custom Car Club to use in magazine and newspaper articles, in flyers and brochures, on TV broadcasting or advertising so Cruisin’ Buddies Rod & Custom Car Club may promote and expand in the area by raising funds for charities, making friends cruising, and preserving old vehicles.
                                       ( Check one Please )     Yes______      No______   


 Signed:_________________________________Dated:___________________________

 ******************************************************************************************

 Member Dues:( Car 30 Years or Older) $25_____

Associate Member: (Newer / Non-Car)  $25_____

 

PRINT AND COMPLETE THIS FORM  [Make Check payable to: CRUISIN’ BUDDIES CAR CLUB]

Mail to:        Kathy Oppici
                    33 Park Street
                    Port Crane, NY 13833
    Phone: (607)-648-3262

OR  Return to: Cruisin’ Buddies Club Meeting 
3rd Wednesday of every month at 7:00pm 
at the Red Oak Diner, Binghamton, NY                     

Back to the Cruisin' Buddies Homepage