Membership Application

Your Name: Your Birthday:
Spouse Name: Spouse Birthday:
Mailing Address: City: State:    Zip:
Phone:                                            Email:
Is this a  Renewal:                  New Membership:    
Do you own a Mustang? Yes:                   No: (Note: ownership is not required)
   
Year Model Color Stock Modified
   
What Are your Interests (Check all that apply): Restoration  Parts Discounts  Locating Parts  Social Activities  Cruises\Road Rallies   Other
How did you first learn about our club? Our Website Facebook  An Invite Card  The IEMC Club Flyer  A Friend  At a Car Show  Other

Dues are per calendar year and are pro-rated based upon when you join the club.  January - July $ 25.00 August - December $15.00

Inland Empire Mustang Club
Attn: Treasurer

P.O. Box 13591
Spokane Valley, WA 99213-3591

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