CENTRAL INDIANA CAMARO CLUB

Membership Application

 *** Print out and mail in with your check ***

Name:  _________________________________

Address:  ________________________________

City:  ________________________

State:  __________

Zip:  ___________

Home Phone:  _______________ 

Work Phone:   _______________

E-mail Address:  ________________________ 

Camaro(s) owned:  _______________________________________

Special Features:   __________________________________________________________

                                  __________________________________________________________
                                   

Spouse (if applicable):________________________________________

Children’s Names (if applicable):  ______________________________   

 Membership dues are $20.00 per year.  Mail application and check, payable to:

Central Indiana Camaro Club

9060 Cooper Rd.

Zionsville, IN 46077

_______________________________     ___________

Applicant’s Signature                                                        Date

 Questions? Call: David Rynard (317) 873-3625 or Doug Harden (812) 988-6556.