MEMBERSHIP APPLICATION FORM
(You will receive an email receipt after your submission has been processed)
Your Name:(Required)

                            
                            
                                                    
                                                    First
                                                
                            
                            
                                                    
                                                    Last
                                                
                            
                        
Your Nickname (Optional):
 
Tell us your nickname (if any) for your Official GSBCC Name Badge!
Spouse or Friend Name (Optional):

                            
                            
                                                    
                                                    First
                                                
                            
                            
                                                    
                                                    Last
                                                
                            
                        
Spouse/Friend Nickname (Optional)
 
Tell us the Spouse/Friend nickname (if any) for their Official GSBCC Name Badge!
Your Address:(Required)
    
                    

                         
                                        
                                        Street Address
                                    
                                        
                                        Address Line 2
                                    
                                    
                                    City
                                 
                                        AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific
                                        State
                                      
                                    
                                    ZIP Code
                                
                    

                
Your Email:(Required)

                                
                                    
                                    Enter Email
                                
                                
                                    
                                    Confirm Email
                                
                                

                            
Your Home Phone:
Your Cell Phone:

Car/Motorcycle Information for Membership Directory:(Required)
Make
Model
Year
 
   Add   Remove
Please Include the Make/Model/Year. 
Click the + to enter more than one vehicle
Upload Vehicle Pictures / Videos (Optional):

										

											Drop files here or 
											Select files
										
									
Max. file size: 256 MB.
 
JPG, PNG, TIF, GIF file formats are preferred, 
MP4 or MOV formats preferred for video clips. If large video files, upload to Youtube or Facebook first and paste the video URL in this box.



NEW MEMBERSHIP DUES $30.00 Annually (January 1 through December 31). If you join in November or December you will have your membership automatically extended through the following calendar year.

MEMBERSHIP RENEWAL DUES $25.00 Annually (January 1 through December 31). Membership Renewals must be paid by the end of January.
New Membership(Required)
Please selectNew Membership



NOTICE:  All members by joining or renewing membership in the Grand Strand British Car Club, (the "GSBCC") grant permission to the GSBCC to publish my name, address, email, phone number, vehicle and other information in the GSBCC membership directory that is accessible to GSBCC members. I also grant permission to the GSBCC to publish photos and videos of myself and my vehicle(s) in print or electronic media including the club's newsletter, promotional materials, website, Youtube channel, FaceBook page or other social media.  I am aware of the hazards inherent with motor vehicle events, and I specifically release and indemnify the GSBCC, its Board of Directors, Officers, organizers of events, and volunteers, collectively and separately from any liability for personal injury or property damage incurred by me or my guests while participating in GSBCC events. The undersigned has read and voluntarily signs this release and waiver of liability and indemnity and further agrees that no oral representations, statements, or inducements apart from the forgoing have been made.
Your Electronic Signature(Required)
 
You agree this acts as your personal signature when you type in your Full Name 
Total Purchase

							
						
This is the amount that will charged to the card below.
Credit Card(Required)
Card Details

					
					Cardholder Name
				
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