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 Club of Southwest Florida
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