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* * * * * PLEASE PRINT OUT AND MAIL SIGNED RENEWAL FORM WITH CHECK * * * * * *
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: ____________
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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:
_____________________
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The 2008 - 2009 Membership fee for the Miata Club of Southwest Florida is $24 per year. All memberships renew on April 1 of each year. Please send this completed Renewal form, along with your check payable to: The Miata Club of Southwest Florida, C/O Steven & Sandy Bowers, 20714 Mystic Way, N.Ft.Myers, FL 33917.