Est. 1980

MEMBERSHIP APPLICATION FORM

Sponsor_______________



Name:_____________________________________________________

Co-Member:________________________________________________

Address:___________________________________________________ 

City:_______________________________________________________ 

State:________Zip:___________ 

Phone:_____________________e-mail:______________________

CAR INFORMATION 

Year:_______ Model:_________________ 

Body Style:_________ Engine__________

Year:_______ Model:_________________ 

Body Style:_________ Engine:_________ 

~~~~~~~~~~~~~~~ 

If you have any cars or parts which you wish to sell or buy, list them below: 

FOR SALE: 
______________________________________________________________ 
_______________________________________________________________ 
_______________________________________________________________ 
_______________________________________________________________ 

WANTED: 
_______________________________________________________________ 
_______________________________________________________________ 
_______________________________________________________________ 
_______________________________________________________________


BASIC CALENDAR YEAR MEMBERSHIP DUES
(Note: Includes 4 Ad Releases)

Domestic U.S. Membership
US $ 24.00
Canadian Membership (Cash or US Bank Check)
US $ 26.00
Overseas Membership (Cash or US Bank Check)
US $ 33.00
 
MONTHLY AD RELEASES
(Note: 8 additional Ad Releases for a total of 12)
If, in addition to your basic membership, you would like to receive our ads on a MONTHLY basis, you can receive AMCRC's Ad Release for the following additional amount:
Domestic U.S. Subscription
US $   8.00
Canadian Subscription (Cash or US Bank Check)
US $   9.00
Overseas Subscription (Cash or US Bank Check)
US $ 10.00
 
Make money orders or checks payable to AMCRC, Inc. 
Please note:
All payments must be made in U.S. Funds ONLY and be on a U.S bank check or in cash. 

AMC RAMBLER CLUB 
77 County Road
Simsbury CT 06070

Brain Yacino (860) 923-0485  Sandy Busque (860) 658-0027
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