membershipsubmission

Name

Phone

Cell

Email

Address

City/Town

Prov

Postal Code

Please submit your Pontiac car information

CAR 1 Year

CAR 1 Model

CAR 1 Type

CAR 2 Year

CAR 2 Model

CAR 2 Type

CAR 3 Year

CAR 3 Model

CAR 3 Type

CAR 4 Year

CAR 4 Model

CAR 4 Type

Additional Comments

Can your Personal Information be shared with Club Members?

Yes No

Would you like to receive by email Club Only related information?

Yes No

AIIPC nor any of the Directors, Members or Volunteers assumes any responsibility for damage or loss incurred at/or during any club or related events. All participants are wholly responsible for their vehicles and belongings.

Do you understand and agree?

Yes