Follow the instructions at the bottom of this page.

Date:     

Name:    

Address:

City:          State:   Zip:

Telephone (Including Area Code):   

Spouse's Name: 

Hobbies Or Interests: 

List Vehicles You Own (Classics, Street Rods or Collector Cars)

Do You Know Anyone In The Lafayette Kroozers?  Yes   No  

If So, Who?

Are You And/Or Your Spouse Willing To Work At Kroozer Car Shows?

  Yes   No If Not, Why?

For use by club:

Accepted:

Rejected: Why? ________________________________________ 

_______________________________________

Date: ________  By:  ________________________________________ 

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