Vintage Automobile Museum of New Jersey

Membership Form

Yes, I want to be part of it today.
             Individual $25
             Senior $15
             Family $40
             Family Life $1500
             Life $1000
             Lifetime Business: A: $10,000 B: $5,000
             Business: A: $1,500 B: $1,000

Name: ________________________________________

Address:  ______________________________________

                   ______________________________________

City: ______________________________ St _________ ZIP _________

Phone (H) ___________________________________ Email ________________________

Name of Club or Organization ___________________________________ Recruited by ___________

Amount Enclosed $______________ Payment Method: _____ Check                                   _____ Money Order

Funded in part by a grant from The Board of Chosen Freeholders For a free Vacation Guide Call (800) ENJOY 33 www.oceancountygov.com