625 Pine Point Circle, Valdosta, GA 31602 - (912) 244-0577, $35/year US
Web Site

                            Application for Membership

Name: ________________________________Phone: _________________________________

Address: ______________________________Occupation: _____________________________

City: _________________________ State: ________________ Zip: _____________________

Type of Buick: __________________Year: ________________Year Purchased: ______________

Engine: _______________________Trans.: _______________Positraction: _____Ratio: ______

Body Color: ___________________________Interior Color: _____________________________

Gear Ratio: ____________________________Stall Converter: ____________________________

Mileage: ______________________________Tire & Rim Size: ____________________________

Stock Modified: _________________________Street/Strip: _______________________________

Best E.T. ______________________ At What Speed: _________Track Length: _______________

Engine Modifications: ____________________________________________________________

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Car Options:____________________________________________________________________

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Is Car Restored?:_________________Entered In Shows?: _______Placed?:____________________

Do You Need Parts?______If So, What:________________________________________________

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What Are Your Special Interests?:_____________________________________________________

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(if you have additional cars, parts needs or other information, please list on reverse side)