MISSL Membership Form

Michigan Impala SS Lovers

MISSL Membership Application Form

Use this form to sign up for MISSL membership. The information that is filled out will get sent via email to our membership coordinator, Mark Proper. Your membership is good for one full year. Membership benefits include:

Admission to club events.

Reduced pricing for MISSL members at special club events.

Your profile on the MISSL web site.(coming soon)

MISSL membership card

You are required to purchase your $25.00 membership via PayPal or by sending a check to the address at the confirmation page. This form eases the data entry burden as well as making it more reliable. Be sure to check the box at the end if it is alright to put this information on the web site on the membership page of the web site and possibly in the newsletter. The * denotes the only information that will be posted to the public.

Legend: Required/Optional

*Personal Information*
*Name:
Address:

City, State and Zip:	,
Home Phone
Work Phone:
*Email Address:
*Web site Address(Non-Commercial Only):
Age:
Occupation:
*Impala SS/B-Body Information*
*Year of Impala SS/B-Body:
*Color of Impala SS/B-Body:
*Vanity Plate:
*Any Special Features or Modifications:
*Feedback*
What things would you like to see the club do?
Anything you would like to see changed?
*Check this if it is OK to put marked information on the MISSL web site.**

Click the submit button to submit your information!