Pacific Northwest Cadillac LaSalle Club
	Membership Application

Name:
Address:
City:		State or Province:
Contact Phone:		Postal Code:
Co-member Name (Spouse, Significant Other, etc.):
New Member or Renewal?:
Enclose $80.00with this form for one year's membership, which includes $50.00 for National dues (depending on level of National membership chosen) and $30.00 for Regional dues. Membership is renewed annually.

List Cadillacs and/or LaSalles currently owned:
	Make	Year	Model #	Body Style
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