Membership Renewal Application

Membership in the Miata Club of Minnesota entitles you to notification of and inclusion in club events.

 

              RENEWAL MEMBERSHIP FEE IS $35.00 PER CAR ANNUALLY. 

MAIL THIS COMPLETED FORM ALONG WITH YOUR DUES TO:

 

MIATA CLUB OF MINNESOTA

 P.O. Box 385554

Bloomington, MN 55438

 

If you have any questions contact the Club Secretary at Secretary@MiataClubMN.com or one of the club officers at www.miataclubmn.com/clubinfo/boardmembers_page.htm

 

NAME:

 

CAR YEAR:

 

ADDRESS:

 

CAR COLOR:

 

CITY/STATE/ZIP:

 

LICENSE NO:

 

E-MAIL:

 

HOME PHONE:

 

CELL PHONE:

 

WORK PHONE:

 

 

YES      NO      LIST MY NAME IN DIRECTORY

YES      NO      LIST MY ADDRESS IN DIRECTORY

YES      NO      LIST MY PHONE NUMBERS IN DIRECTORY

YES      NO      LIST MY E-MAIL ADDRESS

 

In order to speed timing on events, please sign the following form so we can have it on file for your current year of membership.  Thank you.

 

EVENT RELEASE FORM

 

I agree not to hold the Miata Club of Minnesota or its officers liable (personally and professionally) for any accident/damage that may occur to me or my auto during events. I accept full responsibility for my actions.  If I have an accident/damage, I agree to settle the dispute only with the individual person directly involved in the accident/damage. The Miata Club and its officers accept no responsibility either personal or professional for any accident/damage that might occur during the current membership period.

 

Date of Membership:    thru

Name(s):

 

 

                                                                                                                                      

 

                                                                                                                                      

                                  Signature(s):  if appropriate, both sign please