New Member Application "*" indicates required fields Personal InformationName* First Last Spouse/Affiliate First Last Email* Enter Email Confirm Email Date* MM slash DD slash YYYY Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone Number*Phone Is* Home Cell Phone Vehicle InformationYear/Model (Ex. 1961 B) Body Style (Ex. Coupe, etc.) Comments/History on any of the cars:Additional InformationAreas of Interest/ExpertiseI can help the club with (e.g. Legal, Financial, Event Planning, Photography):356 FOG Membership Dues*$30 - 1 Year Membership$60 - 2 Year Membership$90 - 3 Year MembershipPayment Options*How will you be submitting payment? By Credit Card via PayPal link By check Total FOGLight Newsletter*In addition to the email version of FOGLight, would you like to receive the printed version? Yes No Membership Directory*Do you want your email address published in our Membership Directory? The list is not posted on our website and the emailed version is converted to a format that cannot be hacked. * Yes No Consent* I have read and agree to the Privacy Policy*Privacy Policy The information in the Membership Application and/or Gathering Registration form will be used for internal Club purposes only. It will not be shared, sold or made available to any outside organizations, people or advertisers. The Club has an email list used for Club event announcements, reminders, Newsletter transmission, dues collection, and other general information. The email list will not be used for ads, for sale items or personal messages. You will be placed on the list, and if you desire to opt out, you can email the Email Coordinator by hitting Reply on any email you receive. Typical volume of emails is one or two per month.CAPTCHANameThis field is for validation purposes and should be left unchanged.
