Membership Application
RIVER CITY MUSTANG CLUB
Application
LaVonne Kirks (Secretary)
426 Edgewood Dr.
Danville, Va. 24541
www.rcmcsite.com
Club dues are 20.00 per year.
Please include your payment with application to the address above.
Upon receipt and review of your application, you will be notified.
Please Print Clearly
Name:______________________________________________________
Mailing Address:_______________________________________________
City:____________________ State:________ Zip:_______________
Home Phone:_________________________ Cell Phone:_______________
Email Address:_______________________________________________
Please list additional family members who will be part of this membership. If not specified by each name, all correspondence will be sent to the applicant above.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Your Mustang
Year:______________________ Model:____________________________
Style:________________________________ Color:_________________
Shirt Size________________________
Mustang Club Interest: Please check each of your expressed interest of participation.
Car Show____ Cruise-ins____ Restorations___ Social Activities___ Parades___
Serving on Club Committee___ Judging Car Shows____
By my signature, I give permission for the information regarding myself and my family to be used by the Officers and Directors of the River City Mustang Club for Club business only, including publication of my name, address, and phone number in the directory. I have read and agreed to the terms of the by-laws set forth by the River City Mustang Club
Signature:__________________________________________ Date:______________
If any questions contact LaVonne Kirks at 434-799-9634