MEMBERSHIP APPLICATION

The Shifters Car Club is dedicated to the preservation and enjoyment of pre-1970 automobiles.  This family oriented club meets on the second Thursday of the month at 7:00 p. m., Little Lake Auto Parts 1571 South Main Street, Willits, California 95490.  You can look forward to a full spectrum of activities that are organized according to member interest and include: card shows, meets, picnics, parties, and good times centered around The Shifters Car Club.

The application process for membership in the Shifters Car Club is open to anyone sharing an interest or ownership in pre-1970 automobiles.  Membership includes a monthly newsletter, activity calendar, reference material, free want ads, for sale listing and other Shifter Car Club related articles.

Additional membership information for The Shifters Car Club may be obtained by calling Dave Bouthillier at 707-459-6831, or by completing and mailing the application to the above address.

Please Print:

NAME:___________________________________________________________________

ADDRESS:________________________________________________________________

PHONE (H)___________________________PHONE (W)__________________________

BIRTH DATE:_______________/__________________/________________________

VEHICLESYEARMAKEMODEL

__________________________________________________________________________

___________________________________________________________________________

A current and valid vehicle registration, insurance validation card and a current and valid drivers license, as required by state law, are mandatory for anyone who owns and/or operates a vehicle while participation in The Shifters Car Club events.  I understand that my membership terminates as of the date I fail to comply with any or all state laws regarding the cancellation and/or expiration of my operating license, vehicle registration or vehicle insurance.

Signed___________________________________________Date________________________