Old Pueblo Mustang Club
Membership Registration

Registration Donation: $20.00 per year (family)

(Please print or type)

Name(s)_________________________________Phone____________________

Address ___________________City _________________ST_______ZIP_______

E-Mail address __________________________________

Mustang Club of America # (if applicable):___________Exp. Date____________

Mustang Vehicles Owned
Car #1 Year____________Model______________
Car #2 Year____________Model______________
Car #3 Year____________Model______________

Mail to: Old Pueblo Mustang Club
c/o Gary Van Rikxoort
PO Box 8412
Tucson, AZ 85738
Make checks payable to: Old Pueblo Mustang Club.
Information:
Gary Van Rikxoort  (520) 469-5992

OPMC Homepage:http://opmctucson.org

Signature _____________________________ Date _________

REGISTRATION WILL NOT BE ACCEPTED WITHOUT
SIGNATURE
Thank-you