Member Application

Buicks on the Bricks

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Become a member

Please Select One *

Renewal New Member

* Indicates required field

Name *

First

Last

Spouses Name *

Address *

City *

State *

Zip Code *

Home Phone Number *

Cell Phone Number *

Email *

Buicks Owned (Year, Model, Body Style) *

I am interested in PARTICIPATING in...... *

Car Tours Car Shows Technical Sessions Dinner Meetings Restoration Advice Visits to Restoration or Collector Facilities Technical Data Club News & Fellowship

Please select all types of chapter events you would like to participate in.

I am interested in HELPING with..... *

Club News Letter Event Photography Membership Assistance Car Tour Volunteer Meeting Set Up Volunteer Technical Assistance Other (Please explain in the "Comment Box")

Please select all types of chapter events you would like to assist in.

BCA membership is required for membership in the buicktown chapter.

please check and fill out one of the options:

Membership in the bca includes....

participation in national and regional events
the buick bugle monthly magazine
liability insurance coverage in chapter meeting and events

Membership Status *

BCA Member # (existing members only) *

Expiration Date (existing members only) *

New Members Application Date *

Buicktown Yearly Dues (Please select your option)

chapter dues are due in January. the following year is included if you join after august 31st.

Please Select One *

$20 Newsletter by USPS mail (us only) $15 Newsletter by email

Please mail membership checks to:

dave langdon - membership chairman
8246 washburn rd
goodrich, mi 48438-9277

Comment *

Tell us about yourself.....

Submit

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HOME
EVENTS
BCA - BUICKTOWN CHAPTER
PHOTOS
- MEMBER'S PICTURES
CONTACT
- Member Application