MEMBERSHIP APPLICATION

Name: _	Date of Application:

Address:

City:

State: ___ Zip:

Telephone: _

Cell Phone: _

E-Mail Address:

Make:	Model:	Year:

Applicant Date of Birth: _	Family Birthdays:

Name	Birthdate	Name	Birthdate	Name Birthdate	Name Birthdate

Wedding Anniversary Date:	Sponsoring Member Signature: _

The Officers, Directors, and Members of the Kool-Time Kruisers, Inc. are not responsible for any damage or harm to a member's person or property.

Additionally, the Kool-Time Kruisers, Inc. accepts no liability for any member vehicle or actions resulting from activities involving the member or the vehicle.

Applicant Signature:	_	Date: