Please complete this form and present it at a meeting or mail to :
Virginia Jaguar Club
6281 Boundary Run Drive, Mechanicsville, VA 23111-6293
Check One: New [ ] Renewal [ ] Change Club [ ]
Name: ________________________________________________
Spouse or Significant Other Name: ________________________
Address: _____________________________________________
City: ______________________ State: _______ Zip: ________
Phone: Home-(_____ )_____________ Office(_____ )_________
E-Mail Address: ________________________FAX (___)______
Occupation (optional): __________________________________
Drive Jaguar(s) Daily? Yes [ ] No [ ]
Maintenance By: Dealer [ ] Independent [ ] Self [ ] Combo [ ]
Jaguar #1: Year ______ Model ___________ Body Style ________
Jaguar #2: Year ______ Model ___________ Body Style ________
Jaguar #3: Year ______ Model ___________ Body Style ________
Other Cars (don't need to own a Jaguar to join!):______________
Interests (Check All that Apply):
[ ] Concours [ ] Judged Shows [ ] British Car Shows
[ ] Social Events [ ] Road Trips [ ] Rallies
[ ] Restoration [ ] Racing [ ] Technical Sessions
[ ] Charitable Events
I am interested and/or are willing to serve on (check all that apply):
[ ] Car Shows [ ] Rallies [ ] Racing
[ ] Newsletter [ ] Web Site [ ] Membership
[ ] Charitable Events
Type of Membership:
[ ] Regular $52 ($17 JCNA + $35 Club Membership) (Until June 30th)
[ ] Regular $40 ($17 JCNA + $23 Club Membership) (After June 30th)
[ ] New to Club/Existing JCNA Member $35 (Club Membership)
(Memberships include spouse/S.O. and terminate 12/31/00)
Signature: _______________________ Date: _____________
Make Checks payable to "Virginia Jaguar Club"