Michigan Buick Performance Club

(aka Michigan Chapter - Buick Gran Sport Club of America)

Membership Application

2016 - 2017

NAME:______________________________________________GSCA#:________________

ADDRESS:_________________________________________________________________

CITY:_________________________STATE:________________ZIP:___________________

PHONE:____________________________

email: _______________@_____________

BUICKS OWNED:____________________________________________________________

___________________________________________________________________________

BEST ET____________________BEST MPH________________________

INTERESTS:

Drag Racing________

Restoration_________

Shows _____________

COMMENTS:__________________________________________________________________

 


DUES $15 US
 Send Check or Money Order to:

Michigan Buick Performance Club

Dave Hemker

15011 East Street Road
Montrose, MI 48457