Southside Buggistas (SSB)

Membership Application

Full Name:

E-Mail:        

Second Email:

Address:

Home Phone/Cell:

How did you hear about us?        

What type of car(s) do you have?

        

Best way to contact you (email, phone, text)?

Would you be willing to receive texts regarding upcoming events for SSB?  

If so, what is your cellular service provider?

(eg. we can send show notices from email as text messages to phones: 6307899876@txt.att.net)

Additional Comments:

Send membership form to: Diane Rutter, 27263 S. 88th Ave. Monee, IL 60449  

If sending a check, make it out to Diane Rutter. Membership is due yearly by May 1.