Membership Signup – Clay County Cruzers

Date *

Account/Customer Information

Primary Contact Person *

First

Last

Primary's Birthday - Only enter day & month

Car # 1 Year, Make and Model

Car # 2 Year, Make and Model

Car # 3 Year, Make and Model

Car Club Affiliation

Email *

Cell Phone Number *

Street Address *

Address Line 1

City

State / Province / Region

Postal Code

Please list additional Family Members here with Name, Birthdate, Cell phone # and Email

CURRENT Cruzer Members Order here

Please tick the desired items

NEW Members Order here (April thru Sept)

Please tick the desired items

Total Amount

$0.00

Stripe Credit Card *

Card

Name on Card

Are you willing to... Please check all that apply

Help Organize Functions
Hold an Office
Serve on the Board or Committees

Please list any special talents you have that may be of interest to the club, i.e. Graphic arts, computer, Vendors, DJ, Machine Shop, Special Business, Restoration Skills, etc.

The above requested information is voluntary and is used exclusively by club officers to maintain their pledge to provide the most useful help possible to our members. All information listed on this page will be held in strictest confidence and is for the use of the club officers only. No information will be shared with any other organization or business.

Confirmation *

I acknowledge that upon submitting this form, my orders are final and can no longer be canceled

Sign up and pay for membership here

Account/Customer Information

CURRENT Cruzer Members Order here

NEW Members Order here (April thru Sept)