NAME ______________________________________________________________________

            ADDRESS____________________________________________________________________

            CITY_____________________________STATE _____________ZIP_____________________

            HOME PHONE________________________WORK  PHONE____________________________

            Year of T/A____Color(int.)______(ext.)______Engine:________ Auto______Manual_____

            Convertible_______T-Tops________Hardtop______

            Model( T/A,Formula,Firebird,GTA,etc.)______________________________________________

            Special Modifications____________________________________________________________

            Insurance Carrier________________Exp. Date__________License No._____________________

            Email Address_____________________Personal Web Page Address______________________

            Firebirdsofprey email address name eg. myname@firebirdsofprey.com_____________________

            Autoforward to above personal address   Yes____    No_____

            Special Interests: Rallies___Autocross___Drag Racing___Fun Runs___Show N Shine___

            Trips___Socials___Other__________________________________________

            Membership Type

            Individual/Family $40/yr.______

            Please make check payable to , Capital City Firebirds, and mail to