PCA Membership Application - Down East Region, Zone 1

PCA Dues are US $42.00/year. You may pay by credit card or check (payable to "Porsche Club of America, Inc."). Please print this form, fill it out and mail it to:

PCA Executive Office P.O. Box 1347 Springfield, VA 22151-0347

Print out this page and mail in. Click here if you prefer to apply on line.

You should print and mail the completed application with your credit card information or check payable to "Porsche Club of America, Inc." (* = Required Field)
Name*:
Address*:
City*:	State*:     Zip*:
County*:
NOTE: Member may name EITHER a Family or Affiliate co-member, NOT both. Family or Affiliate member must be 18 years or older.
Family Member:	Relationship:
OR Affiliate Member:
Preferred Region Affiliation:
Porsche Information:
Model*:	Body Type*:   Year*:
Color*:	Serial Number (Required)*:
Car used:	Daily? For Pleasure?
PCA REGIONAL ACTIVITY INFORMATION         Your Age:
Occupation:	Telephone:
Complete E-Mail Address:
Marital Status: Single: Married:     Spouse's Name:
List name(s) and age(s) of children:
Interests:	Technical:	Social:	Concours:
	Autocrossing:	Rallying:	Driver's Education:
Porsche Maintenance performed by: Self: Dealer: Independent:
Visa/MC # * (if paying by card):	Exp. Date*:
Name as it appears on card*:
I first learned about PCA From: BMW Roundel Ad: Car & Driver Ad: Mercedes STAR Ad: Road & Track Ad: AutoWeek Ad: Porsche Market Letter (PML) Ad: PCA Member: Panorama Magazine: duPont Registry Ad: Automobile Magazine Ad: PCA Web Site: Other Internet Site: Specify: Other Source:         Specify:

 

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