Name 2: _____________________________

Address: ____________________________

City: ________________, State _______ Zip: _________

OCCUPATION/BUSINESS __________________________________________

PHONE (Home)_________________, (Work) __________________

E-MAIL ADDRESS _______________________________________

CAR #2
MFG.__________, MODEL __________, YEAR ___________, COLOR_____________

CAR #3
MFG.__________, MODEL __________, YEAR ___________, COLOR_____________

CAR #4
MFG.__________, MODEL __________, YEAR ___________, COLOR_____________

I AM INTERESTED IN (Check all that apply):

[Ralleys _____, Autocross _____, Car Shows _____,

Parties _____, Picnics _____, Tours _____,

Tech. Information _____, Parts/Service Discounts _____, Other _____]

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APPLICANTS MUST BE NINETEEN (19) YEARS OF AGE OR OLDER

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SIGNATURES:

Member #1 _______________________________, Date: ____________

Member #2 _____________________________________, Date: ______________

Please print and fill out above form and send (with check payable to the Arizona Z Club) to:

Arizona Z club, P.O. Box 335, Youngtown, AZ 85363-0335

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