2009

W.P.C. CLUB - PUGET SOUND REGION
ROSTER UPDATE
And
MEMBERSHIP APPLICATION

    This is an interactive form. Fill in the blanks on your computer,
    click the print button at the bottom and mail it to:
    WPC Club Inc.
    c/o Patty Carson
    P.O. Box 513
    Woodinville, WA 98072

    Check One:    New Membership ,   Renewal or    Roster Update Only

    First Name      Last Name

    Spouse / Partner     Street Address
     
    City       State    Zip Code

    E-Mail:   Phone Fax

    Chrysler Products Owned (List Year, Make, Model, Body Style )

        Year                      Make                          Model                          Body Style
    1.         
    2.         
    3.         
    4.         
    5.         

    Dues are $18.00 for 1 year and are due by December 31st in order for you to
    appear in the January Chapter Roster. Please make checks payable to: WPC Club Inc.
    c/o Jon Carson, P.O. Box 513, Woodenville, WA 98072

    PLEASE NOTE: The above does not include membership in the National W.P.C.
    Club.     (It is a prerequisite that you belong to the National W.P.C. Club when
    joining a region.) National dues are $35.00 for 1 year, and can be sent to:
    The W.P.C. Club, P.O. Box 3504, Kalamazoo, MI 49003