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APPLICATION ($25.00)

Applicantís Name:

Date:

Spouse / Signif. Otherís Name:

Address:

City, State, Zip

Phone:

E-mail

Your Month and Day of Birth:
__________/___________

Spouse / Sig Other Month and Day of Birth:
__________/___________

Vehicle Information: (year, color, model, make, etc.) ______________________________________________________________________________

______________________________________________________________________________

Additional Information (optional):

Other Club Affiliations:___________________________________________________________

Occupation: ___________________________________________________________________

Hobbies: ______________________________________________________________________

Wedding Anniversary: ___________________________________________________________

Children/Names: _______________________________________________________________

I hereby agree to hold harmless the Cruisers of South Florida, Inc. from any loss, liability, damage or costs that might accrue.

Signed: _________________________________________ Date: ____________________

Mail Application and Check to:
Cruisers of South Florida, Inc.
5000 Cleveland St
Hollywood, Florida 33021

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