MEMBERSHIP FORM (Click BLUE Button).

2017 CAR SHOW Registration






                                                                       MEMBERSHIP APPLICATION
                                                                    Pacific Performance Pontiac Club Vancouver BC Canada
                                                                                                  P.O.Box 24  Maple Ridge
                                                                                                    BC  V2X 7E9   Canada

(Please print this page and complete in full )


Name:____________________________________
Spouse/Mate:____________________________

Address:________________________________________________________________

City:_________________________________Prov/State:________________Postal
Code/Zip:_______

Phone:________________________Country:_________________________Date:_________________

Email:________________________________________________

Pontiac's Owned:

Year:___________Model:_________________Style:_____________________

Year:___________Model:_________________Style:_____________________

Do you object to being listed in a
Club Directory for members? Y / N

Other Car Club
Affiliations:_____________________________________________________

How did you learn of Pacific
Performance Pontiac Club?______________________________

____________________________________________________________________________

Please indicate any areas of
interest or expertise you could make available to the club or
members?____________________________________________________________________

____________________________________________________________________________

Signature:_________________________________

Dues are $30.00CDN per year
pro-rated to Feb 1st. Please contact Membership Chairman for details.

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CLUB
USE ONLY

Date
received:_______________________Dues(amt):__________________________

Member number:_____________________
exp. 02/01/15

 

   PPPCC