Annual Membership Dues:
Individual - $30        Family - $45

To join or to renew, please complete this online application.  (Renewing members, please fill
out this form so we know your information is current).  Then mail your check or money
order for the appropriate dues amount to:

Mopar Magic Unlimited Auto Club, Inc.; PO Box 52081  Shreveport, LA 71135

New members receive a club t-shirt, window decal, monthly newsletter and admission to
special club events!

Thanks, and welcome to the Club!
MoPar Magic Club Membership Application
Your First Name: *
 Your Spouse's First Name:
Your Last Name: *
 Your Spouse's Last Name:
Your Birthday (MM/DD):
 Your Spouse's Birthday (MM/DD):
Street Address: *
City: *
 State: *
 Zip Code: *
Home Phone  (XXX) XXX-XXXX*
 E-Mail Address
Work Phone  (XXX) XXX-XXXX
 Occupation
* indicates required field
Please List Mopars Owned. (Optional - Ownership is not required for membership.)
T-Shirt Size(s)
Family Members' Names and Dates of Birth - If you'd like announcements in the newsletter.
dodge,plymouth,jeep,chrysler,desoto,hemi,ram,louisiana,east texas,dodge,plymouth,jeep,chrysler,desoto,hemi,ram,louisiana,east
texas,dodge,plymouth,jeep,chrysler,desoto,hemi,ram,louisiana,east
texas,dodge,plymouth,jeep,chrysler,desoto,hemi,ram,louisiana,east texas,
NOTE FOR CURRENT
MEMBERS

DO NOT
use this
form
for
ANNUAL
RENEWAL
OF
MEMBERSHIP!

This form is for NEW
member
applications
ONLY!!!