Membership Application

Online Membership Application

Southern California Miata Club
23052-H Alicia Parkway #247, Mission Viejo, CA 92692
Membership Dues is $25.00 a year.

Online Membership is $26.06 USD a year. which includes a $1.06 USD processing fee.

Just fill out our online membership application and click on the "Submit " button.
Continue on to the Payment Page and remitt membership payment of $26.06. It's that easy!

Primary Member
First Name:
Last Name:
Address Street 1:
Address Street 2:
City:
Zip Code:	(5 digits)
State:
Birthdate:
Secondary Member
First Name:
Last Name:
Birthdate:
Contact Information
Daytime Phone:
Evening Phone:
Cell:
Email Address:
Newsletter Delivery
newsletter:
Car Information
Year:
Color:
Car Nickname:
Licence:
Purchased:
Transmission:
Interior:
Option Package:
Hard Top:
Modifications:
Other Information
Would you like to join our club's private yahoo groups email?:
How did you hear about SOCALM:
Payment Options:
Comments:

Terms of Membership:
The member(s), by signing below, assumes responsibility for all actions of
themselves and any guests attending a SOCALM event. Both driver and
passenger in a member’s car acknowledge acceptance of this liability waiver
and agree to follow all the laws of the State of California while participating
in r traveling to or from SOCALM events. Renewal of membership constitutes
continuing agreement with these terms. Failure to adhere to these terms may
result in termination of Membership at the discretion of the SOCALM Board.

Electronic Signature:
By Clicking the "Submit" button you consent and agree that your use of a key pad,
mouse or other device to select an item, button, icon or similar act/action while using
any electronic service we offer; or in accessing or making any transactions regarding
any agreement, acknowledgement, consent, terms, disclosures or conditions constitutes
your signature, acceptance and agreement as if actually signed by you in writing. Further,
you agree that no certification authority or other Third party verification is necessary to
the validity of your electronic signature; and that the lack of such certification or third party
verification will not in any way affect the enforceability of your signature or any resulting
contract between you and Southern California Miata Club.

Membership Directory Listing: The SOCALM member directory is available online via our club website. It is the policy of SOCALM not to release names, addresses, phone numbers, or any other personal information without the prior written consent of the individual member. The member may change or revoke his/her permission upon written notice to the membership chair.