Please download and print this form to apply for membership. Sorry, we're not high-tech enough to process your application and payment over the web. See item 9 below.

Northern California Kit Car Club membership application

your name_________________________________ home ph (____) __________

address____________________________________ work ph (____) __________

city, state, zip__________________________________________date_________

email contact___________________________email at home or work? _______

1. kit car name_________________________mfr: _______________________

chassis info_______________________________________________________

engine info_______________________________________________________

transmission info__________________________________________________

2. status: under construction ____ completed ____ purchased finished ____

   Assembled by _________________________

3. Club activities you prefer _________________________________________

4. Will you participate in club committees? Yes___ No___

5. Is it insured for: liability___ physical damage___ insurance co. ________________

6. Do you plan to sell your car in the near future? Yes___ No___

7. How did you learn about the NCKCC?__________________________

8. Name of spouse/navigator __________________________

9. Annual dues $24/year, or prorated at $2/month to end of calendar year (check payable to NCKCC). Please remit your club dues to: Vern Hance, 3317 Ellesmere Court, Walnut Creek, CA 94598-3902. We look forward to having you in the NCKCC!

10. We'd appreciate a photo of your car for our club album. Click here for tips on how to photograph your car like a professional.