MEMBERSHIP APPLICATION
NAME AGE
STREET ADDRESS
CITY STATE ZIP
EMAIL PHONE #
 
NOSTALGIA GASSER INFO
YEAR MAKE MODEL
ENGINE
E.T. RANGE
(PLEASE ATTACH PHOTO OF CAR)

YEARLY DUES ARE $25 FOR RACERS, $20 FOR NON-RACERS, PAYABLE EACH OCTOBER 1ST. ALL MEMBERS WILL RECEIVE:

  • CLUB DECALS

  • MEMBERSHIP CARD

  • MONTHLY E-MAIL NEWSLETTER ONCE THE 2002 RACE SEASON STARTS.

PRINT THIS OUT AND SEND COMPLETED FORM, PICTURE AND CHECK FOR $25 OR $20 TO:
EAST COAST GASSERS
2395 BRIAR RIDGE RD.
HARLEYSVILLE, PA.19438