OFFICIAL MEMBERSHIP FORM

NAME:

ADDRESS:

CITY:

 STATE:       ZIP:

E-MAIL ADDRESS:

CAR MAKE:   MODEL:   YEAR:

CAR COLOR:

DOES YOUR CAR HAVE A NAME?  :

HOW DID YOU HEAR ABOUT THE INDY CRUISERS?

PLEASE PROVIDE ANY ADDITIONAL INFO OR FUN TIPS ABOUT YOU OR YOUR CRUISER THAT YOU WISH TO SHARE INCLUDING YOUR BIRTHDAY (not year):