Membership Application

Print this page and mail in via snail mail

Name _____________________________________________

Street _____________________________________________

City _____________________________________ State ____

Country ___________________ Postal/Zip Code ___________

Phone _____________________________________________

Email _____________________________________________

Model Year of Hurst/Olds _____________________________

VIN Number(s)______________________________________

___________________________________________________

Color ______________________________________________

Owned Since________________________________________

Original or Restored?_________________________________

Mail this form, along with $25 in U.S. funds for one year's dues, to:

H/OCA Membership Coordinator
3098 S. Point Pleasant Rd.
Decatur, IL 62521

Thank you for your interest in the H/OCA