revised January 1 2017
MEMBERSHIP APPLICATION

Please print, fill out, and return to:

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 group and being added to the listserver ! Please contact me by e-mail when my membership takes effect.
    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 ONE, TWO or THREE 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 .