Gateway Chapter Membership Application and Profile Sheet
Annual dues are $15 to the Gateway Chapter renewed in May each year.
(BCA membership required also for club liability insurance)
Family & Personal Information
Name ______Birth month ______
Spouse's Name ______Birth month ______
Wedding (mo/yr) ______
Number of Children ______Number of Grandchildren ______
Mailing Address: ______
______
City, State, Zip Code ______
Home Phone ______Work Phone (optional) ______
e-mail Address or other information ______
Profession ______
Employer ______
Years ______
Spouse's Profession ______
Employer ______
Years ______
Buick Club of America Information
You are required to be a BCA member
BCA # ______
Buicks now owned ______
Model (Roadmaster, Skylark, etc) and Body Style (sedan, 2dr Hardtop, etc.)
About your other car interests
Collector cars now owned other than Buicks
______
______
Member of other car clubs
______
______
Other auto related interests
______
______
About your other interests
Hobbies, collections other than cars
______
______