Houston City Cruisers Membership Application
(A PT Cruiser club run by its members.)
(Please Print Legibly)
First Name:___________________ MI:___ Last Name:_____________________________
Birth: Month____Day____ T-Shirt Size:_______
Associate Member: (i.e. spouse)_____________________________ Birth: Month____Day____
(Membership card will be based on above information for you and associate member.)
Address:_________________________________________________________________
City:_________________ State:__________ Zip Code:_____________
Home Phone:____________________ Cell Phone:__________________
E-Mail Address:______________________________________________
Color of PT__________________ Year/Model_____________________
How did you hear about us?_____________________________________
The membership fee is $50 for the first year and shall be renewed annually at $20 per PT Cruiser owner thereafter.
Check Number:_______ Amount Paid:_________
Please make checks payable to Houston City Cruisers and mail to:
Jerry Smith, 827 Spring Source Place, Spring, TX 77373
Signature of applicant:________________________________________ Date:_______________