www.azhighlandcruisers.com

 

MEMBERSHIP ENROLLMENT FORM

COST: $8.00 PER PERSON / $12.00 PER COUPLE per year

NAME ________________________________ Birthday ________________________

                                                                                                                                                                                (mm/dd)

NAME ________________________________ Birthday ________________________

                                                                                                                                                                                 (mm/dd)

ADDRESS _____________________________________________________________

 

CITY ________________________________ STATE __________ ZIP _____________

 

PHONE ________________________ EMAIL ________________________________

 

PT CRUISER COLOR __________________________TURBO yes _______ no ______

 

WEDDING ANNIVERSARY DATE _________________________________________

                                                                                                                                  (mm/dd)

 

I realize that activities for this club may involve some potential hazards. I agree that the AZ Highland Cruiser Club and it’s officers and members

shall not be held liable by me, my relatives, my heirs, legal guardian or representatives for any act that may result in

my injury or death while freely participating in any activities sponsored or organized by the aforementioned club/organization.

 

Signature ______________________________Date ________ Total Enclosed $ _______

Check, Cashiers Check or Money Order made payable to: Steve Hyslop/AZ Highland Cruisers

 

Mail to:

Steve Hyslop

PO Box 25774

Prescott Valley, AZ  86312

                                                                                                                           Referred by ____________________________________