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: __________________________