928 Owners Club Membership Application

You

Name: ________________________________Address: ___________________________________

City ___________________State/Prov: __________ZIP/Postal Code: ___________Country:_______

Day Phone: ( ___ ) ____-_______ Evening Phone: ( ___ ) ____-_______ Fax: ( ___ ) ____-_______ 

E-mail: ___________________________ 

Member E-mail List Message Preference:  Real-Time ___ or Digest Mode ___

Personal Web site: _______________________  T-shirt Size: __S  __M  __L  __XL  __XXL  __XXXL

YOUR CAR 

928 model:  928:  ( __ ) 928S:  ( __ ) 928S4:  ( __ )  928GT:  ( __ ) 928GTS:  ( __ )
Year: 19____	 VIN: ______________________5 sp:  ( __ ) auto:  ( __ ), US:  ( __ ) Euro:  ( __ ) 

Modifications:_____________________________________________________________________

YOUR INTERESTS 					YOUR ACTIVITIES IN THE CLUB
__ technical 							__ write articles
__ concours 							__ organize local events
__ social 							__ evaluate cars for member purchase
__ performance driving events (autocross, track) 	__ other (please indicate):_______________
__ modifications (power, handling, appearance) 
__ other (please indicate):_________________


HOW YOU HEARD ABOUT THE 928 OWNERS CLUB

__ print advertising				__ internet search
	__ Pano
	__ 928 Forum			__ Rennlist

__ word of mouth				__ 928OC Public List


Download, complete, make $28.00 check payable to 928 Owners Club, mail to:
		
928 Owners Club
Attn: David Lloyd, Membership Chair
10 Chapel Road
Farmington, CT 06032-2126  USA