Membership Application

* Fields are optional at the time of application but are required when signing membership agreement.

Full Name Address City State Zip Code Day Phone Evening Phone E-Mail Address Date of Birth Occupation * Driver's License State/Number * Insurence Company / Policy Number Emergency Contact Name Emergency Contact Phone Number Personal References Name Phone Number Name Phone Number Do you belong to any other car clubs?           Yes   No If yes, please list Vehicles Owned Personal Biograhy & General Interests

		Membership is offered to anyone qualifying to criteria set by NYMC's insurers. Applicants must fit our age criteria, provide reference from a suitable person, and maintain a driving record that is within reasonable limits. NYMC will make any and all inquiries necessary establish the suitability of an applicant, and reserves the right to refuse membership to anyone without reason. Our board of directors will, on a case-by-case basis, consider applicants who fall outside restrictions, taking into account factors such as driver and insurance profiles.