91 Wainwright Avenue, Closter NJ 07624

2008 MEMBERSHIP REGISTRATION FORM

Name _______________________________            DOB ______/________/_________
Address _______________________________________________________________
City ________________________________ State _________________ Zip _________
Telephone: Home  ____________________ Business ___________________________
E-mail ______________________________________

MEMBERSHIP FEES
Single member:  $45.00
Spouse and additional *family members at a $5.00 discount each (Please write family members below

CAR NUMBERS
Please indicate your first four preferred car numbers. You will be assigned a permanent number of your choice for the duration of the season

Please enter at least one vehicle that you may wish to register

Vehicle 1: ____________________________	Vehicle 3: ________________________________
Vehicle 2: ____________________________	Vehicle 4: ________________________________

Please select your membership option

Upon submission of this registration form to The M Club, I, the undersigned, understand the responsibility as a driver.  I will conduct myself in a manner that is respectful to the other drivers.

Signature _____________________________________                                         Date _____/______/______

Check here if you are interested in volunteering for event coordination/planning
*Must be immediate family and over 21 years old.