Membership Application

NCCA#

Name

First Name

Last Name

Phone

(###)

###

####

Occupaiton

Insurance Company

LIST SERVICES YOU COULD PERFORM FOR OTHER REGIONAL MEMBERS, SUCH AS WELDING, MACHINING, UPHOLSTERING, PAINTING, ETC. EITHER ON AN EXCHANGE OR FEE BASIS

CAR MAKE & MODEL YEAR MODEL# BODY STYLE #CYL. CONDITION

SO CAL REGION DUES ARE $10.00 PER YEAR,

NATIONAL DUES ARE 35.00 PER YEAR ELECTRONIC DUES ARE $18.00

Annual dues are due by April 1st

NEW MEMBERS JOINING NOV. 1ST AND AFTER RECEIVE MEMBERSHIP FOR THE REMAINING YEAR AND THE FOLLOWING YEAR FOR $10.00. THEREAFTER DUES PAYABLE ON OR BEFORE APRIL 1ST.

NOTE: ALL REGIONAL MEMBERS MUST BELONG TO THE NATIONAL CLUB PER THE NCCA BY-LAWS, ARTICLE VIII, SECTION II

PLEASE REMIT TO: NCCA SO CAL REGION C/O LARRY KROEZE 891 N. HILLSIDE DR., LONG BEACH, CA. 90815. PH. 562-799-9274