New Membership Information Form

We appreciate your interest in

Roadtoads On-Line Street Rod Club

All information is kept confidential and is presented to the Board of Directors

To move from field to field hit tab or click in the field

Today's Date:

19

Are you on AOL (America On-line)? Sorry but this is the only current way to participate is via AOL

Yes         No

Can you or could you attend 4 meetings (online) in a one month period?  Meetings are every Wednesday and Sunday evening between 7p.m.-11p.m CST

Yes         No

Do you own a vehicle of pre-1949 vintage? Guests are welcome but to become a member you must own a vehicle of pre-49 vintage

Yes        No

Your AOL Screen name?        

Your 1st Name(or Nickname)?

Your City?                                                                                 

Your State?                                   2 Characters

Year of your car:  

Make:   ie:Ford/Chevy/Chrysler

Model: ie:A/B

Style:   ie:2 door/4 door/Roadster/Cabriolet

About You:About Your Ride:

If accepted as a member, would you like to have a picture of your car published to the Roadtoads Website?

Yes   No

If accepted as a member, do you have a picture of your ride in jpg/jpeg format? Yes   No

Optional

The following questions are not required to be filled out for consideration for membership but would be helpful for the future.

Take care as you fill out the following information it will be protected as it is filled out.

Last Name:

Phone:        format 123-456-7890

Address:  

Homepage:

                                             

Thanks again for taking the time to fill out the Membership Information Form

Back to Roadtoads Online Homepage

Last Updated on 12/19/99
By Rick Shelton, Hotrod28a@aol.com