revised March 4 2020
MEMBERSHIP APPLICATION

CHRYSLER 300 CLUB INTERNATIONAL, INC.
PO Box 40
Benson, MD 21018

  • NAME:   _______________________________________________


  • SPOUSE:  _____________________________________________


  • ADDRESS: ____________________________________________


                               ____________________________________________


                              _____________________________________________


  • PHONE: (____) ____________________         CELL PHONE: (____) ____________________
  • FAX: (____) ____________________


  • EMAIL ADDRESS: _____________________________________


  • YES____ NO_____ : I am interested in joining the Club's free on-line discussion group - listserver.
    PLEASE LIST ALL CHRYSLER 300 AUTOMOBILES CURRENTLY OWNED
    Vehicle Serial Number (VIN) Year Ht / Cvt Color List of Options









































    MEMBERSHIP DUES effective 1/1/17: US and Canada $35.00 per year. Foreign $40.00 per year. Payable 1, 2 or 3 years in advance.
    We can accept dues via Paypal. For information, contact bob@simplexco.com

    Please, U.S. Funds or International Bank Draft only. Add $20.00 to dues to cover PNC bank charge on International wire transfers .