Name____________________________________________ DOB _____________________

 Spouse___________________________________________ DOB _____________________

 Address_____________________________________________________________________

 City _____________________________________State__________ Zip ________________

 Phone #_________________________________

 Cell phone #  ____________________________

 Email ____________________________________  Anniversary______________________

 Vehicles you own and love :

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

 Things you do or find interesting other than cars :

_____________________________________________________________________________

_____________________________________________________________________________

 Send completed form along with a check for $15.00 (yearly dues)  to :

 Glen Logas

 19643 Cedar Drive

 Cedar, MN 55011