The Miata Club of Southwest Florida

MEMBERSHIP APPLICATION / RENEWAL

 

Name: __________________________________    Spouse/Significant Other: __________________________

 

Birth Date: (Mon. /Day) ____________________     Birth Date: (Mon. /Day) ____________________________

 

Florida Address: __________________________________________________________________________

 

Northern Address (If applicable):______________________________________________________________

 

If Seasonal, what months are you typically in SWFL?  _____________________________________________

 

Telephone Number: _____________________________ Other Phone: ________________________________

 

E-mail Address: __________________________________________________________________________

 

Miata Year: _______________ Color: ___________________

 

First Name(s) you would like on name badges (new members only):_____________________________________

 

Please indicate an area of interest that you are willing to help out with as a member of MCSWF during the coming year:

 

            Newsletter, Stories: _____                                          Dealer Liaison, Advertising, etc.: _____

 

            Event Planning and Implementation: _____                      Club Officer, Board Member: _____

 

            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 Southwest 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 fees for the Miata Club of Southwest Florida are $25 per year per car (April 1 – March 31).    All memberships expire on March 31 of each year.  New members who join for the first time after Oct. 1 of each year will pay $15.  Please send this completed form, along with your check payable to:

Miata Club of Southwest Florida, c/o Judy Western, 3006 Caring Way #306, Port Charlotte, Fl 33952.

Miata Clubof Southwest Florida

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