Membership Application

Print this page and mail in via snail mail

(Please allow 30 days for processing)

Name _____________________________________________

Street _____________________________________________

City _____________________________________ State ____

Country ___________________ Postal/Zip Code ___________

Phone _____________________________________________

Email _____________________________________________

____ Place an X to the left if you do not want your Email

published in the Members Reference Manual.

Model Year of Hurst/Olds _____________________________

VIN Number(s)______________________________________

___________________________________________________

Color ______________________________________________

Place an X for: New Member______ or Renewal______ / Member #_______

Make check payable to H/OCA

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

H/OCA Membership Coordinator
Craig Lynch.
P.O. Box 715
Port Royal, SC 29935

Thank you for your interest in the H/OCA