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MEMBERSHIP APPLICATION

EAST GRAND PACKARDS

A Region of Packard Automobile Classics, Inc.

Membership* (requires membership in Packard Automobile Classics)                         $15.00

NAME_______________________________________SPOUSE___________________

ADDRESS______________________________________________________________

CITY___________________________________STATE_______ZIP________________

OCCUPATION (optional)___________________________________________________

HOME PHONE__________________ FAX_____________ BUSINESS_____________

E-MAIL____________________

                                                     PACKARDS OWNED

            Year         Series           # of cyl         Body Style            Condition

1. ______________________________________________________________________

2. ______________________________________________________________________

3. ______________________________________________________________________

4. ______________________________________________________________________

Please use reverse side if needed for additional Packards or comments.
Are you a member of  Packard Automobile Classics ?      ____Yes       ___No PAC #______
What other auto organizations are you a member of? ______________________________
Will you be willing to serve the club as an officer__________ or on a committee_________

Member's Signature _____________________________________ Date____________

 

Return completed form to:

Natalie Brown,

PO Box 336,

Barneveld, N.Y. 13304

 

 

315-896-2539

wanabrown@roadrunner.com

 

Make checks payable to East Grand Packards