Name(s):________________________________________________________________

Address:________________________________________________________________

City:__________________________________ State:___________ Zip:_____________

Phone#:_______________________________ Cell#:____________________________

E-Mail:_________________________________________________________________

Birthdays________________________________________________________________

Annv:___________________________________________________________________

How did you hear about Columbia Classics ____________________________________

Vehicles:

Membership information provided will be published in the club roster.

Initial here if you DO NOT WANT your information published in our club roster _______________

Mail completed form and a check for $20.00 (per family) to Columbia Classics Car Club "Attention Registration" P.O. Box 6509, Kennewick, WA. 99336. If you require additional information, please send an E-Mail to the clubs mail box located on the front page.

Date Paid:____________________

Rec’d By:_____________________

Cash:__________ or CK#:________

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