MCCDC MEMBERSHIP APPLICATION

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Membership runs from January 1 - December 31

To become a new member or to renew your membership, please complete this form and send with a check for $27.00 made out to MCCDC as payment to:

MCCDC c/o Pat MacAuley, Acting Registrar, 9605 Chevalle Dr., Manassas VA, 20112

Telephone: 703 331 4777 Email: THEMACMOG@aol.com

FOR CLUB YEAR ENDING DEC. 31, 20 New Renewal Note changes Renewals due Dec. 31

MEMBERSHIP INFORMATION

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NAME____________________________________________SPOUSE_____________________MEMBER NO._______________

ADDRESS_______________________________________________________________________________________________

CITY_____________________________________STATE_______________COUNTRY____________ZIP/POST CODE__________

HOME TELEPHONE_____________________________ OFFICE TELEPHONE_________________________ext.______________

CELL PHONE/FAX/OTHER________________________EMAIL_____________________________________________________

Necessary for you to receive periodic email about events.

YEAR JOINED or INTERMITTANT YEARS OF MEMBERSHIP___________________ MCCDC OFFICES HELD & YEARS_________________

CAR INFORMATION

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YEAR MODEL TYPE COLOR(S) NAME SPECIAL CHARACTERISTICS

Body/Wings of Car

___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________

MEMBER ACTIVITY / INTEREST AREAS CIRCLE OR UNDERSCORE ANY/ALL INTERESTS

ACTIVITIES PRESENTLY ENGAGED IN:

RESTORATION - MAINTENANCE - WEEKEND ROAD TRIPS - VACATION ROAD TRIPS - RALLIES - AUTO SHOWS - CLUB CONCOURS –

AAC RACING - VINTAGE RACING - SCCA RACING - AUTOCROSS - OTHER _____________________________________________________

ACTIVITIES I WOULD LIKE TO PARTICIPATE IN:

TOURS - WEEKEND GETAWAYS - BRUNCHES - RALLIES - GYMKHANA - CONCOURS - AUTOCROSS - HILL CLIMBS - FIELD TRIALS - VINTAGE RACING - TECH SESSIONS – HOST A NOGGIN - OTHER ______________________________________________________________________________________________________________

I WOULD ATTEND ACTIVITIES ON: WEEKENDS - SATURDAYS - SUNDAYS - WEEKDAYS

I HAVE THIS GREAT IDEA! ______________________________________________________________________________________________________________

I WANT TO VOLUNTEER FOR: OFFICE: ______________________________ COMMITTEE: _________________________ EVENT: ___________________________

MCCDC MEMBERSHIP APPLICATION

FOR CLUB YEAR ENDING DEC. 31, 20 ____ New____ Renewal____ Note changes____ Renewals due Dec. 31

MEMBERSHIP INFORMATION

CAR INFORMATION

FOR CLUB YEAR ENDING DEC. 31, 20 New Renewal Note changes Renewals due Dec. 31