Date Paid_____________

Method: ______________

Route 66 Cruisers Car Club

Please complete form and mail with your $15 check to:

Route 66 Cruisers

%Kaye Meacham

2550 Highwood Drive

Claremore, Ok. 74017.

Thank you for renewing your membership dues promptly.

Name_______________________________________________________________

Address______________________________________________________________

City____________________________________________State_________________

Phone_____________Cell_________________Email__________________________

Year and Make of Car___________________________________________________

Original ________________Modified________

Please check one: New Member ___________________Renewal________________

Annual Dues for Car Club Membership is $15 a year, dues cover the 2010 calendar year

and are due by January 1, 2010.

Dues Enclosed: $______________________make checks payable to: Route 66 Cruisers

_____________________________________________________________________

Route 66 Cruisers Car Club

Cut Here for Your receipt to Keep for your records

Paid Membership Dues Date: ______________________________________________

Method of Membership Paid ______________________________________________

Name _______________________________________________________________