* * * * * PLEASE FILLOUT, SIGN AND MAIL RENEWAL FORM WITH CHECK * * * * * *

The Miata Club of Southwest Florida
2010-2011 MEMBERSHIP RENEWAL

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:  ____________

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 out 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:  _____________________

The Membership Renewal 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 Steve & Sandy Bowers, 20714 Mystic Way, North Fort Myers, Fl 33917.