COLORADO
LAND CRUISERS
Membership Application
Membership type desired:*Reg____*Asoc.____*Asoc.Com._____
Name:__________________________________ Date: ________________
Spouses Name:___________________________ TLCA #______________
Mailing Address:_______________________________________
City:_____________________________ State:______ Zip:_____________
Home Ph.: (____) _____-___________ Work Ph.: (____) _____-________
CB Handle:____________________________
Vehicle: 19____, _____________________ Model:___________________
How did you find out about Colorado Land Cruisers?__________________
_____________________________________________________________
If applicable:
Fax: (_____) _____-____________ Email Address:___________________
*Regular, Voting Membership; you must meet the following requirements:
*Associate Membership:
*Associate Commercial Membership:
Please fill out this application and bring it to our next Club meeting. Feel free to contact our Membership Chairperson, Rob Grimes, at (719)475-7609, or email grimes@pcisys.net .
TLCA dues are $20/yr and the responsibility of the individual Regular Member.