revised 11-11-2007
MEMBERSHIP APPLICATION

Please print, fill out, and return to:

CHRYSLER 300 CLUB INTERNATIONAL, INC.
PO Box 40
Benson, MD 21018

  • NAME : _______________________________________________

  • SPOUSE : _____________________________________________

  • ADDRESS: ____________________________________________

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  • PHONE : (____) ____________________

  • FAX : (____) ______________________

  • EMAIL ADDRESS: _____________________________________

  • YES____ NO_____ : I am interested in joining the Club's free on-line group and being added to the listserver ! Please contact me by e-mail when my membership takes effect.
    PLEASE LIST ALL CHRYSLER 300 AUTOMOBILES CURRENTLY OWNED
    Vehicle Serial Number (VIN) Year Ht / Cvt Color ---- List of Options ----
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    MEMBERSHIP FEE: US and Canada $25.00 per year. Foreign $30.00 per year. Payable ONE, TWO or THREE years in advance.

    Please, U.S. Funds, or International Bank Draft ONLY !