The Packard Motor Car Foundation

49965 Van Dyke Avenue

Shelby Twp., MI 48317

 

FRIENDS OF THE PROVING GROUNDS

Printable Membership Form

(Use your "Print" icon on your browser or on the "File" menu or Google browser menu)

 

            Name ___________________________________________________________________

 

            Address _________________________________________________________________

 

            City _____________________________ State ______________ Zip Code ____________

 

            Overseas please provide Country _____________________________________________

         

    ______ $30 Individual

 

    ______ $20 Individual Senior (60+)

 

    ______ $45 Family

 

    ______ $100 Contributor

 

    ______ $250 Supporter

 

    ______ $500 Benefactor

 

    ______ $1000 Life 

 

             By Check: payable to: The Packard Motor Car Foundation or

 

            By Credit Card:

            Fill in your ______Visa, ______MasterCard, ______Discover, or ______American Express 

                

            Card number: ________ ________ ________ ________ Expiration date: ____   ____ Security Code (Back of card): _______

                                                                                                                                     (mm)   (yy)

            Name and billing address on card must match the name and address above.

           

            and mail it to:      Packard Motor Car Foundation

                                        49965 Van Dyke Ave.

                                        Shelby Twp., MI 48317

 

Thank you for your support. We look forward to your joining the friends.

 

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