JOINName*Spouse or FriendAddress* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home PhoneCell PhoneEmail Address* Car Information for Membership Directory* Year/Make/Model NEW MEMBERSHIP DUES $30.00 annually (January to January). New members joining after October 1st will be credited for the following year. RENEWAL MEMBERSHIP DUES $25.00 annuallyMembership Type*Please selectNew MembershipRenewal MembershipI give my permission to list my phone and email address in the membership directory to be accessible to members only.*YesNoI agree to allow GSBCC to publish my photo(s) in print or electronic media including the GSBCC website and facebook page.*YesNo As a member of GSBCC, I agree to hold GSBCC, its Board of Directors, Officers and organizers of events free from all liability for any accident or injury which may occur in connection with club events.Signature*You agree this acts as your personal signature when you type in your Full NameAmount Enclosed $0.00 Date* Date Format: MM slash DD slash YYYY Credit Card*American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 Expiration Date Security Code Cardholder Name PhoneThis field is for validation purposes and should be left unchanged.
