JOIN THE FUN
Badgerland Miata Club
Membership Application
Annual dues - $30.00
Make checks payable to:
Badgerland Miata Club
% Terry Lucas
Secretary/Treasurer
2127 Springbrook South
Waukesha WI 53186

PLEASE CAREFULLY PRINT ALL INFORMATION - THANKS

Today's date ________________________

Member Name: ________________________________________________

Co-Member Name: _____________________________________________

Member name as you'd like it to appear on namebadge: ____________________________________________

Co-member name as you'd like it to appear on namebadge: _________________________________________

Address: ___________________________________________________

City: ____________________________ State:_______ Zip:____________

Phone:____________________________

E-mail Address:_________________________________

Your Miata - Year:______________ Color:_________________ License:________________

More Miata - Year:______________ Color:_________________ License:________________


The Badgerland Miata Club assumes no liability for any injuries or damages to a member resulting from membership in this club.