| Membership Application Form Full Name_______________________________________________Phone________________________ E-Mail_______________________________ Personal Webpage_________________________________ Address______________________________________________________________________________ City________________________________________________State______________Zip_____________ Vehicle Details Make________________________ Model______________________________________Year_________ Accessories___________________________________________________________________________________________________ ________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________ Favorite places to drive your 4x4______________________________________________________________________________ ________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________ Club trips you'd like to see____________________________________________________________________________________ ________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________ Images Please email us any images of yourself (any image format) which you would like to have posted in the member pictures section. You can also email us online links to images of you and your rig which would like us to add to the section. If you wish, you can also send us a floppy with your image files. Club Feedback How did you learn about us?__________________________________________________________________________________ ________________________________________________________________________________________________________________ Club Fees A $5.00 club fee is due along with a Self Addressed Stamped Envelope (SASE) when you submit this form. Upon receipt of this, we will send members a Club Vehicle decal. Additional decals are $5.00 each. Where To Submit This Form Please mail this form, a check or money order for $5 (& any additional decal fee's), along with a SASE to... Ray Sala 1285 Manchester Drive, #1 Santa Clara, CA 95050 Form MFWDC-01A-031302-A |
| MITSUBISHI FOUR WHEEL DRIVE CLUB OF NORTH AMERICA http://www.geocities.com/mitsubishifourwheeldriveclub |
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