JAGUAR DRIVERS AND RESTORERS CLUB

OF NORTHWEST AMERICA (JDRC/NWA)

NEW MEMBERSHIP APPLICATION

4701 SW Admiral Way #294, Seattle, WA 98116

Name                                                                                                                                                                                                    

Spouse/Other                                                                                                                                                                                       

Address     

Home Phone:

 

Fax:

Cell Phone:

Email#:

 

Providing the following information is optional. It will be published in the club roster coming out in April.

Applicant

Spouse/Other

Business Phone # 

Business Phone # 

Occupation: 

Occupation: 

 

Hobbies: 

Hobbies: 

Jaguar(s) currently owned: (use back page if more space is needed)

Model Year

Model

Body Style & Color

 

 

 

 

 

 

 

Please check any following interests:

________Rallies                       ________Helping with JAG MAG                  ________Technical/Restoration

________Tours                         ________Organization of an event              ________Slalom

________Annual Concours               (party, dinner mtg, etc.)                         Other:                                                

 

Annual renewal dues are $60.00  Make checks payable to JDRC/NWA. (use above address)

 

I (we) wish to further the aims of the Jaguar Drivers and Restorers Club of Northwest America, and if accepted for membership, do hereby agree to abide by its bylaws.  Note: This information may be used by any JDRC/NWA members.

 

Signature                                                                                                                        Date                                                             

 

Membership chair:       Vickie Kollmar       jagsforus@aol.com         (206) 938-2021

 

For dept. use only  

Received date____________ Ck# ______ $ ________ JCNA______Database _____ Letter____

Jagmag _____ Roster______ Sticker ______ Treasurer ______ Paypal ______ JCNA# ________