JUKEBOX CRUISERS CAR CLUB

P.O. Box 4024 Jim Thorpe, PA 18229

OFFICIAL JUKEBOX CRUISERS MEMBERSHIP APPLICATION

Membership is open to individuals 18 years of age or older with a valid driver's license and current automobile insurance. By signing the application they agree to be a responsible person and follow the club's bylaws. They should have a general interest in or own a classic, antique or special interest vehicle. All applicants must be sponsored by a member in good standing.
CAR OWNERSHIP IS NOT REQUIRED TO JOIN!
Application fee is $15.00 and includes dues for the current year.
All applications must be presented at a business meeting using a JBCCC application form.

PLEASE PRINT ALL INFORMATION BELOW

MEMBER NAME __________________________________________________________

SPOUSE NAME ____________________________________________________________

MEMBER BIRTHDAY _________________ SPOUSE BIRTHDAY _________________

ADDRESS _________________________________________________________________

CITY ________________________________ STATE __________ ZIP _______________

HOME PHONE ________________________ WORK PHONE _____________________

EMAIL ADDRESS ______________________________________________________

MAKE OF VEHICLE _________________________ MODEL ________________

YEAR OF VEHICLE _____________________

_____________________________________________________________________

APPLICANT'S SIGNATURE & DATE

_____________________________________________________________________

SPONSOR'S SIGNATURE & DATE

Click Here To Print Or View From PDF File!

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