MEMBERSHIP APPLICATION FOR

               REBEL ROUSER’S CAR CLUB

______ Please check if new member              ______ Please check if renewing membership

Membership will cover you and your spouse or companion.  He or she will have the same rights as the primary member, including the right to vote in the election of officers, and to hold an office, or to become an elected board member.  Individual member-ship cards will be issued at no extra charge to a spouse or companion.  Note: only one newsletter will be sent to the primary address.

NAME:_________________________________________________________________________                                                                 LAST NAME, FIRST NAME,  MIDDLE INITIAL

SPOUSE/COMPANION___________________________________________________________                                                                  LAST NAME, FIRST NAME,  MIDDLE INITIAL

STREET ADDRESS:  ___________________________________________________________________

CITY/TOWN: ______________________________ STATE:  _______________________

ZIP CODE:  ___________________ HOME PHONE:  (           )___________________________

*****New applicants will require a sponsor*****

A sponsor is a member in good standing with dues paid up to date with Rebel Rouser’s Car Club.

MY SPONSOR’S NAME IS:_______________________________________________________

MY SPONSOR’S PHONE NUMBER IS:  (______)_____________________________________

PLEASE LIST IMPORTANT DATES WITH NAMES AND DATES OF BIRTHDAYS AND ANNIVERSARIES, ETC.  USE BACK OF PAPER IF NEEDED.  ________________________________________________________________________________________

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*****MAKE, MODEL, AND YEAR OF THE VEHICLE YOU WILL BE SHOWING*****

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Submit this application along with your check or money order in the amount of $15.00 to the address below and you will receive your membership kit within a week.  You will receive a newsletter near the beginning of each month. Send to:

REBEL ROUSER’S CAR CLUB, INC.

JUDY STROUD

5900 E. COUNTRY CLUB ROAD

LOGANSPORT, IN 46947-8454