Professional Car Society - Southern California Chapter
   
                           Membership Application
   
    1. Print out this form.
    2. Fill it out completely (items marked with # are optional)
    3. Mail this form, with your check or money order for the appropriate
       amount to:
       
   Professional Car Society - Southern California Chapter
   432 E. Fairmount Rd
   Burbank, CA 91501-1706
   
      Name: _______________________________________
   
   Address: _______________________________________

            _______________________________________
   
      City: _______________________________________

     State: __________   Zip: _____________________

     Phone: (____)__________ #Fax: (____)__________

   #E-mail: _______________________________________ 
   
   #Professional cars owned:
   ______________________________________________________________________
   ______________________________________________________________________
   ______________________________________________________________________
   ______________________________________________________________________
   ______________________________________________________________________
   
Southern California Chapter dues enclosed ($20.00 per year):   $_________
   
      * National membership dues enclosed ($30.00 per year):   $_________
   
                                             Total enclosed:   $_________
   
   * Membership in the International Professional Car Society is required
   to be eligible to join any local chapter.