American Clipper Owners Club

NEW MEMBER APPLICATION

  • New Member dues are $30.00 per year.
  • Membership term is from February 1 to January 31 annually.

Please answer the following questions so we can be of assistance to you.

  • Did you receive all back issues of the American Clipper Newsletter when you purchased your American Clipper? ____Yes ____No
  • If you did receive the Newsletter, what is the last issue number you have________.

PLEASE PRINT OR TYPE THE FOLLOWING INFORMATION AS YOU WANT IT TO APPEAR IN THE DIRECTORY

LAST NAME___________________FIRST____________________SPOUSE_____________ Address______________________________________________________________________ City____________________________________State_____ ZIP+4_______________________
Phone ( )_________________ E-mail__________________________________________

Referred by Member #_______________________________(not required)

 

YEAR

21'

24'

REAR KITCHEN

REAR BATH

BUNK

ENGINE 360/400

ENGINE 440

 

DODGE

                 

CHEVROLET

                 

Please fill in the year of your vehicle and place an "X" in the appropriate box.  This is internal information not for publication.

Enclose your check payable to AMERICAN CLIPPER OWNERS CLUB  for $30.00

Mail your check to:

ACOC MEMBERSHIP REGISTRATION
1880 Countrywood Court
Walnut Creek, CA 94598

This application was provided by:_______________________________ ACOC #__________

Updated Oct 2005