High Plains Region
Nash Car Club of America

Membership Application

Please print this form and mail it with your check to the address below

Name:

 

Spouse:

 

Address:

 

City:

 

State:

 

Zip Code:

 

NCCA Membership #:

 

Telephone (home):

 

Telephone (work/cell):

 

Fax Number:

 

E-Mail address:

 

Mail completed form to:
High Plains Region, NCCA
Tim Heckel , Treasurer
41 Via Chula Vista
Manitou Springs, Colorado 80829

(719) 578- 8381

 

Membership in The Nash Car Club of America is required.

Include your check payable to: High Plains Region, NCCA. DUES are $12 per year. Thank you.


NCCA Recognized Cars Owned: (list additional cars on back if necessary)

Year

Make

Model #

Model Name

Body Style

Condition*

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*Note: Use NCCA Condition Ratings   1 = Excellent   2 = Fine   3 = Very Good   4 = Good   5 = Restorable   6 = Parts Car

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