ORANGE EMPIRE REGIONAL GROUP

APPLICATION FOR MEMBERSHIP

Date of application: Approval Date:
Name: Spouse’s name:
Street Address: City, State, Zip +4
Phone:

E-Mail Address:

Insurance Carrier:
Please list antique, or other, cars you own

Make

Year

No of Cylinders/HP

Body Type

Membership in National Horseless Carriage Club is mandatory for membership in the Orange Empire Regional Group. Please indicate your National HCCA membership number:

Ownership of an antique automobile is not a requirement of membership, only the interest in automobiles. Link to website: http://www.oerg.hcca.org/

Applicant must be recommended by an OERG member in good standing.

Name of sponsor: ______________________________

Signature of sponsor: ____________________________

Dues: $20.00 per year (single or family)

Send completed and signed application along with a check made out to OERG to:

Roger Berchtold  350 La Plaza Dr.  La Habra, CA 90631

The following is optional, but we would like to recognize the significant dates below:

New Member: Birthday:(mm/dd) __________________

Spouse: Birthday:(mm/dd) _______________________

Wedding Anniversary: __________________________

 

Back to Membership Page

HOME PAGE