MEMBERSHIP APPLICATION
Annual dues are $20 and are renewable each April. (New members joining mid-year will be pro-rated.) Membership includes a subscription to our bi-annual newsletter, this informational website, a club window sticker, a club key chain and an invitation to all club-sponsored events.

Please Check One : ___New Membership ___Renewal

Your Name:_________________________________ Spouse/Partner:_____________________________

Street Address:______________________________ City, State, zip:______________________________

Home Phone: ( ___) __________ Cell Phone: ( ___) __________ Email:__________________________

TELL US ABOUT YOUR COUGAR(s)!

YEAR
MODEL
ENGINE
TRANS
VIN
COLOR
OPTIONS/History
             
             
             

Signature: _______________________________

Date: ______________

Lists developed from this membership roster will be for private use by the club and not distributed for commercial purposes.

Please make your check for $20.00
Annual Dues Payable To:Cougar Club of New England

Mail to:
Cindy Ghizzi
350 Walnut St.
Shrewsbury, MA 01545
STAFF USE ONLY BELOW
Processed By: ______________________ Date Received: _________Amount Received:________
Member #: ____________Expiration Date:______________
Notes: