Membership Application

First Name	Last Name	Spouse Name

Address 1

Address 2

City	State	Zip

Home Phone	Cell Phone

Email Address 1	Email Address 2

Miata Year & Color	When did you buy it?	Does it have a name yet?

How did you hear about our club?

There are two ways to submit this form:

1. Print this screen out and snail mail it, along with $20, to:
Carolinas Miata Club
1829 Dickerson Blvd., Box 129
Monroe, NC 28110-2759

2. Click the Submit button below to send the form electronically,
then go to www.paypal.com and send $20
to Treasurer@CarolinasMiataClub.com.

(Click OK on the pop-up asking if you want to transmit your email address.)
(Click SEND on the pop-up asking if you would like to send the message.)
(If you don't do these steps, we won't get your application.)