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* * * * * PLEASE PRINT OUT AND MAIL SIGNED APPLICATION * * * * * *
The Miata Club of Southwest Florida
MEMBERSHIP APPLICATION
Name: ____________________________ Spouse/Significant Other: ________________________
Birth Date (mo./day): ________________ Birth Date (mo./day): _____________________________
Florida Address: _______________________________________________________________
Northern Address (if applicable): ________________________________________________________
Telephone Number: ________________________ FAX Number: ________________________
E-mail Address: ________________________ Other Phone: ________________________
Miata Year: ________ Color: ____________ Package: _________________________________
First Name(s) You Want On Club Badge(s): __________________________________________
If you are a member of the Miata Owners Club, please list your membership number here: ___________
Please indicate an area of interest that you are willing to help our with as a member of MCSWF during the coming year:
Newsletter, Stories:___ NewsletterMailing, Advertising, etc.:___
Event Planning and Implementation:___ Club Officer or Area Events Director:___
Other (explain):_________________________________________________________________
IMPORTANT: PLEASE READ CAREFULLY AND SIGN. WITH YOUR SIGNATURE, YOU AGREE AND ACCEPT THE FOLLOWING STATEMENTS AND CONDITIONS: As a Member of the Miata Club of South West Florida, I agree to obey all traffic laws, including speed limits, and set a positive example for other drivers. I acknowledge that any driving event, whether on a public road or on a track, involves danger and risk. I will not hold the Miata Club of Southwest Florida, its Officers, Members or assigns responsible for any accident, mishap or injury that may occur during any activity or event, or during travel preceding or following such activity or event.
SIGNED: ___________________________________________ DATE: _____________________
SIGNED: ___________________________________________ DATE: _____________________
Membership dues for the Miata Club of Southwest Florida are $24 per year. All memberships renew on April 1 of each year. For new Members joining within the Club's fiscal year, dues are $24 April 1 to September 30 and $12 October 1 to March 31. Please send this completed Application, along with your check payable to: The Miata Club of Southwest Florida, C/O Steven & Sandy Bowers, 20714 Mystic Way,North Fort Myers, FL 33917