Name

Mailing Address

City, State, Zip Code

Home Phone

Cell Phone

Work Phone

Email Address

Detail of Car(s):

Make / Year / Description

Make / Year / Description

Make / Year / Description

If you have any special interests, suggestions for club activities, membership meeting guest speakers, or any other general comments, list here:

Once you have completed this form:

Mail form and $25 membership fee to:  NILBMC  - P O Box 665 - Warsaw, IN 46581-0665 or

Bring completed form to the next membership meeting with your $25 membership fee or

Come to the next membership meeting and complete the membership form there