MICHIGAN CHAPTER Gran Sport Club of America Membership Application 2001 - 2002

NAME:______________________________________________GSCA#:________________

ADDRESS:_________________________________________________________________

CITY:_________________________STATE:________________ZIP:___________________

PHONE:____________________________

email: _______________@_____________

BUICKS OWNED:____________________________________________________________

___________________________________________________________________________

BEST ET____________________BEST MPH________________________

INTERESTS:

Drag Racing________

Restoration_________

Shows _____________

COMMENTS:__________________________________________________________________

Do you need a nametag? _________Name to engrave _______________________________

DUES $15 US
 Send Check or Money Order to:

Michigan Chapter - GSCA
Barb Birdsley- Treasurer
7103 W. Frances Rd.
Flushing, MI 48433
(810) 639-5967