| Pacific Northwest
Region |
amt
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| Nash Car Club of America |
by ___________ |
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| Membership Application/Renewal |
exp __________ |
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Spouse |
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NCCA Membership # |
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State or Province |
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ZIP or Postal Code |
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E-Mail |
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| Mail Completed Form to: |
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Include your
check made payable to: Pacific Northwest |
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| Pacific
Northwest Region, NCCA |
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Region, NCCA. Dues
are $12 per year, and all dues |
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| Jerry
Knutsen, Treasurer |
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expire on March 1. Dues
paid on or after September 1 are |
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| 150 Melrose Ave. E. #108 |
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$6 for the remainder of
the year until March 1. Dues paid |
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| Seattle,
WA 98102-5524 |
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on or after
January 1 include any remaining time until |
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| (206) 328-4533 |
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March 1 plus the entire
following year. |
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| ambassador8@AOL.com |
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Please remit in U.S.
funds. Thank you. |
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| NOTE: Membership in the Nash Car Club of
America is a pre-requisite for membership in the |
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| Pacific Northwest Region. |
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| NCCA
Recognized Cars Owned: (list additional cars on back if necessary) |
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Make |
Model # |
Model Name |
Body Style |
Condition * |
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| *Note: Use NCCA Condition Ratings 1 = Excellent 2 = Fine 3 = Very
Good 4 = Good |
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| 5 = Restorable 6 = Parts Car |
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