Maverick Comet Group membership application

Full Name  ____________________________________________

Mailing Address _______________________________________________________
                _______________________________________________________

Phone #         ________________________

Year/Make/Model(2dr/4dr) ______________________________________________
Color: exterior/interior ______________________________________________
Engine/Transmission      ______________________________________________
Other information        ______________________________________________
                         ______________________________________________
                         ______________________________________________
                         ______________________________________________
                         ______________________________________________

Year/Make/Model(2dr/4dr) ______________________________________________
Color: exterior/interior ______________________________________________
Engine/Transmission      ______________________________________________
Other information        ______________________________________________
                         ______________________________________________
                         ______________________________________________
                         ______________________________________________
                         ______________________________________________

(Repeat for multiple cars)

E-mail address _______________________________________________

Signature _________________________________________ Date _______________
(Your typed name here constitutes a signature in email format)


We respect your privacy.  Your contact information will only be used for 
official club business.