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MEMBERSHIP APPLICATION

LEHIGH VALLEY LEGENDS

                                                                                              MOTOR VEHICLE ENTHUSIASTS

 

 

REFERRED BY:                                                                                                                                        DATE         /      /

 

 

NAME:

BIRTHDATE:

ADDRESS:

CITY:

STATE:

ZIP CODE:

TELEPHONE:

SPOUSE’S NAME:

BIRTHDATE:                  

ANNIVERSARY:                  

CHILDREN (UNDER AGE 12)           /        /           D.O.B.         /       /

                                                                  /        /                                /       /

                                                                 /        /                                /       /

 


VEHICLES OWNED:     YEAR   /   MAKE   /   MODEL

IF MORE SPACE IS NEEDED USE BACK

                                                              /                  /

                                                              /                  /

                                                              /                  /

                                                              /                  /

 

 

MEMBERSHIP DUES ARE AS FOLLOWS:  $20.00

DUES SHALL BE PAYABLE TO:

LEHIGH VALLEY LEGENDS

1123 ˝ OAK ST.

COPLAY, PA  18037

 

PLEASE VISIT OUR WEBSITE: www.lehighvalleylegendscarclub.com