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National CCCA New Membership Application
Print this form and mail with your check or credit card information to the address below.
Active (USA): $45.00 Canada & Mexico:$50.00 (USD) Other Foreign: $57.00 (USD)
Associate (Spouse of active member only) : $7.00
Make checks payable in U.S. Funds. Life Membership available after 10 years Active Membership
Name:___________________________ Associate name: __________________________
Address:__________________________________________________________________
City:____________________ State:_____ Zip:___________ Country:________________
Home Phone:(____)_________________ Office phone:(_____)_____________________
FAX:(_____)_____________________ Email:___________________________________
Enter below Classic Cars you own with complete description. It is not necessary to own a Classic car to enjoy membership in CCCA. Cars for which complete descriptions are not provided will not be listed in the Roster. Cars must be CCCA-approved Classics, 1925-1948. See "What is a Classic" elsewhere on this Web Site. If additional space is needed, please use the back of this form.
Classic car #1
Classic car #2
* Premier, Senior, and Primary First Place Winners at CCCA Grand Classics or the Annual Meeting list Senior number. If the number is unknown, please furnish owner's name when the car became Premier, Senior or Primary Winner and/or former owner. Make Check Payable in US Funds to CCCA and mail with this application to:
CLASSIC CAR CLUB OF AMERICA q My Check is enclosed
1645 Des Plaines River Road, Suite 7A Charge to: 1645 Des Plaines River Road, Suite 7A
Des Plaines, IL 60018-2206 Charge to: MasterCard Visa Card
Phone: (847) 390-0443
Fax no: (847) 390-7118 Sign below and return with your check or charge info.
X__________________________________________ Account _______________________ Exp. Date:______
Foreign Air Mail: Add $48.00 (U.S. Funds) for Europe; Add $56.00 (US Funds) for Asia/South Africa; Add $65.00 (US Funds) for the Pacific Rim.
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