yes, send my 1 year membership for only $39.99 (U.S.A)
1 year international membership for only $54.99 (Payable in U.S. Dollars)
1 year renewal for only $39.99 (Payable in U.S. Dollars)
current membership number_____________________________________
Name: __________________________________________________________________________
Address: ________________________________________________________________________
City: _____________________________ State: ______________ Zip: _____________________
Phone Number: ___(_____)____________________ E-Mail: ________________________________
Year of Car _____________________________ Make / Model _____________________________
Credit Card Information
Check Mastercard Visa Discover American Express
Card #: - - -
Exp. Date: - Total: $ _____________________
Mail completed form along with payment to:
Eckler's Chevy Classics Club
Attn. Membership
5200 S. Washington Avenue
Titusville, FL 32780
or Fax to (321) 383-2059