Wizards of Rods, Inc.

P.O. Box 182

Mauston, WI 53948

wizardsofrods.com

APPLICATION FOR MEMBERSHIP

Date of Application: ________________	Sponsor: _________________
Name: __________________________	D.O.B. ___________________
Spouse: _________________________	D.O.B. ___________________
Anniversary Date: _________________
Children: ___________________________________________________
(first names and ages) ___________________________________________________________

Type of Membership:

· Single (_____)

· Couple (_____)

List vehicles you own that would be considered club cars:

Year	Make	Body Style	Rod/Custom
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________

I, the undersigned, certify that all the information on this application is correct to the best of my ability, and that any misrepresentation may void this application and possibly my membership to the Wizards of Rods, Inc.

Signature __________________________________ Date ____________