M.S.B.A
MEMBERSHIP APPLICATION
PLEASE PRINT THIS PAGE, FILL OUT APPLICATION AND MAIL WITH YOUR $20.00 CHECK OR MONEY ORDER MADE PAYABLE TO M.S.B.A Membership.
M.S.B.A MEMBERSHIP C/O Jim Bernhardt 31244 Barton Gardencity michigan 48135
NAME ____________________________________________________________________________________
ADDRESS ________________________________________________________________________________
CITY ___________________________________STATE___________ZIP__________
PHONE (_______)_______________MEMBERSHIP#__________IF RENEWAL
AS A NEW MEMBER YOU CAN BECOME PART OF ONE OF OUR CHAPTERS.
YES, PUT ME IN THE NEAREST CHAPTER_____NOT A THIS TIME_________
YOUR BIRTH DATE HIS_____________ HERS__________ ANNIVERSARY_____________
WHAT KIND OF BUGGY DO YOU HAVE… TUB BUGGY_____ RAIL BUGGY_______
WHAT DO YOU WANT TO DO AS A MEMBER
HILLCLIMB___DRAG RACES___ TRAIL RIDES___ STREET RIDES___ COOKOUTS __
SHOWS___ BUG IN’S___ SWAPMEETS___ SAND DRAGS___ SUGESTIONS?________
THANK YOU FOR YOUR APPLICATION. YOUR MEMBERSHIP CARD WILL BE IN THE MAIL
