* MEMBERSHIP or RENEWAL APPLICATION *
WASATCH MOUNTAIN CHAPTER SDC
{Please Print}
Name:

Spouse Name:

Address:

City - State - Zip:

Telephone: Mobile:

Birthday Month/Day: Spouse:

Wedding Anniversary - Mo/Day/Yr:

E-mail:

Your Studebaker(s):



SDC Membership #: Exp Date:
(need more space - please use back)

PRINT & MAIL This Form Along With Your CHECK TO:
Membership Chairperson: Candido Gallegos
4750 S. 3685 West, Taylorsville, UT 84118-3435
(make check payable to:) "WASATCH MOUNTAIN CHAPTER SDC"
You may also bring to any club meeting or function
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