Willamette Valley Miata Club
Print this page, fill it out and mail to:
P.O. Box 20612
Keizer, OR 97307
1st year dues are $30.00 this includes the associate member, Renewals are $20.00 per year.
You will receive a WVMC name badge, WVMC car window sticker and full access to our club website.
Primary Members Name: (Please print your name as you would like it to appear on your Club I.D. badge).
Associate members name (ie. spouse):
Year of Miata_______________ Color of Miata_________________________
Got more than one Miata?
Year of 2nd Miata____________ Color_________________________________
City_________________________ State _____________Zip ________________
Cell Phone ______________________
Do you have current insurance? _______ YES _______ NO
Insurance Company Name: ____________________________________
Check here if you do not want your information listed in the club directory