Caprock Cruisers Membership Form

Caprock PT Cruisers Membership Application

$25.00 Installation Membership Fee includes Family Membership, 1 Membership ID Badge

Please Print

Name:_______________________________________	Date:___________________

Address:_____________________________________________


City:_______________________________________	State:_______	Zip:____________________

E-Mail:____________________________

Phone: ____________________________

Vehicle Information (year, color, model, etc.):_________________________________________________


Your Month/Day of Birth:__________________	Spouse Name:_______________	Spouse Month/Day of Birth:___________________


Shirt Size:________ Name:_______________	Shirt Size: _______ Name:________________

Racing Shirts with embroidered logo $20.00 each; add 3.00 each for 2X and above.

Note: Shirts are custom ordered, it is important to provide correct size, car color, and proper spelling of name.

Total Amount enclosed:______________________

I hereby agree not to hold the Caprock Cruiser Club liable for any reason:

SIGNED:_________________________________________________________________

With your paid membership, you will receive 1 Family Membership ID. Extra Membership ID's are $6.00 each.

Please make check payable to Caprock Cruisers, and if mailing, send to Caprock PT Cruisers, 826 S. Kentucky, Amarillo, Texas 79109

Check out our website at http://www.caprockcruisers.com

Chrysler and PT Cruiser are Registered Trademarks of the Daimler Chrysler Corporation. The Caprock Cruiser Club and its web site are not affiliated with the Daimler Chrysler Corporation. The products and opinions expressed on this web site, and sites linked to it, are not necessarily that of the Caprock Cruiser Club, its web site or Daimler Chrysler Corporation. The Caprock Cruiser Club and/or Daimler Chrysler Corporation are not responsible for errors published on this web site.