NASH CAR CLUB of AMERICA (NCCA)

Preservation and Restoration
YES! I would like to enjoy the benifits of Membershipin the Nash Car Club of America.
Date;_____________________ E-mail Address _______________________________________________
Name _________________________________________Spouse _____________________
Street ________________________City__________________________________
State ________________ Zip Code ___________ Phone (______) ____________
If you have belonged to NCCA in the past, please include your old membership number here ___________
OPTIONAL: Check here [___] if you are interested in providing "On The Road Assistance to Club Members"
(ie, have knowledge of location of reliable parts house, garage, open gas station or overnight lodging in your area.)
PLEASE LIST ALL THE INFORMATION YOU CAN. THIS WILL BE USED FOR THE NCCA ROSTER. ADDITIONAL CARS MAY BE LISTED ON A SEPERATE SHEET IF NECESSARY.
___YEAR___MAKE_____MODEL NO._____MODEL_____SERIAL NO.____BODYSTYLE____CYL.__COND.__
__________________________________________________________________________________________
___________________________________________________________________________________________
CONDITION GUIDE
1.) EXCELLENT: Restored to professional stadard in every area; or original with all components as new.
2.) FINE: Well restored: excellent original or extremely well-maintained original showing minimal wear.
3.) VERY GOOD: Completely operable original or older restoration showing wear or amateur restoration; all presentable and serviceable inside and out.
4.) GOOD: A driveable vehicle or a deteriorated restoration or a poor amateur restoration. Components may need restoration , but are mostly useable as is.
5.) RESTORABLE: Needs completre restoration of body, chassis, interior. Not driveable, but not weathered, wrecked or stripped to the point of being useful only for parts.
6.) PARTS CAR: only. Not restorable.
USA CANADA INTERNATIONAL AIR
1 YEAR $30.00 $33.00 $48.00
2 YEAR $60.00 $66.00 $96.00
3 YEAR $90.00 $99.00 $144.00
Lifetime Membership $570.00 $590.00 $950.00
Electronic Membership (No Mailings)
 All $15.00 Per Year
Subscription Length - (Years) X Dues........................................ $_____________
For Credit Card Payment, add $2.00 Fee X Year..................... $___________
Total USD Enclosed......................................................................... $___________
For Credit Card Payment, Please Fill in FORM Below. A fee of $2.00 per year will be charged. - - - Please print legibly.

|___|Visa |___|Master Card |___| Discover

|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___|___| - - Expiration Date |____|_______|

Authorized Signature________________________________________________

MAKE CHECK OR MONEY ORDER PAYABLE TO: NASH CAR CLUB of AMERICA

SEND YOUR REMITTANCE TO: Jay Ciampi, Membership Chairpersons,
460 Bonnie Rd. N.W., Lake Placid, FL 33852-4066