Application for Membership
NorthStar Region of the
Cadillac-LaSalle Club, Inc.
Print application and Mail to Jan Gerecke
New Membership _____ Renewal Membership_____
Name_________________________________Spouse_____________________________
Address_________________________________________________________________
City__________________________________State_______________Zip_____________
Occupation_____________________________Email______________________________
Home
Business
Fax
Phone______________________Phone_____________________Phone_______________
|
Auto/Make |
Year |
Cyl |
Model |
Body
Style |
Body
Builder |
|
1. |
|
|
|
|
|
|
2. |
|
|
|
|
|
|
3. |
|
|
|
|
|
|
4. |
|
|
|
|
|
|
5. |
|
|
|
|
|
 | National
Membership is a prerequisite to Region Membership. |
| As
a condition of membership, members must abide by all rules published by the
National and Regional Clubs. |
| Annual
dues cover fiscal year, February 1 through January 31. |
| Application
received after February 1 will not be included in the Membership Roster
book. |
| Current,
active annual membership dues for the Northstar Region are $20.00 |
Mail to: Jan Gerecke
4304 Woods
Way
Minnetonka,
MN 55345-2970
952-936-7613
Use
reverse side for additional vehicles and/or additional comments.