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AMCOMC New Member Application
What is included with
an AMCOMC membership?
Attendance at our monthly club meetings.
Access to restoration experts, who are also club members.
Exclusive invite to the annual AMCOMC club picnic and holiday party.
An AMCOMC Membership Card, which will grant discounts at participating
Member Sponsor
organizations.
Details about
upcoming car events
, including public shows, private garage tours, events hosted by AMCOMC, and more!
*
Indicates required field
Full Name (First and Last)
*
Street Address
*
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington D.C.
West Virginia
Wisconsin
Wyoming
Zip Code
*
Spouse's Name
*
If you are not married, please leave this field blank.
Member Since (Year)
*
How will you pay your annual dues ($25.00)?
*
I have already paid.
I will send a check.
I will pay at the next club meeting.
Do you have any other club affiliations?
*
If no, please write "No".
Would you be willing to work on a future AMCOMC committee?
*
Yes
No
Email Address
*
Home Phone
*
Cell Phone
*
Date of Birth (mm/dd)
*
If your birthday is September 2, enter 09/02.
Spouse's DOB (mm/dd)
*
If your spouse's birthday is September 2, enter 09/02. If you are not married, please leave this field blank.
If this is a membership renewal, check here:
*
Membership Renewal
Current Work/Trade or Hobby (If Retired or Not Working)
*
Do you do work on your own vehicles?
*
Yes
No
Would you be willing to host an event at your home/garage?
*
Yes
No
Vehicles in Current Collection (Please use large text box below if more space is needed).
Vehicle 1: Year
*
Vehicle 2: Year
*
Vehicle 3: Year
*
Vehicle 1: Make
*
Vehicle 2: Make
*
Vehicle 3: Make
*
Vehicle 1: Model
*
Vehicle 2: Model
*
Vehicle 3: Model
*
If you need to add more vehicles, add them here.
*
Please be sure to include the year, make, and model of your vehicle(s) as you did above.
NOTICE OF DISCLAIMER
Please note that membership is contingent on the execution of this section.
This Relationship (“Membership”) is submitted by and between the Antique Motoring Club of Monmouth County (d/b/a “AMCOMC”, “Organization”) and the signee below (“Member”). “Member” assumes all responsibility for all related risks, dangers, and hazards, and agrees that “Organization” is not responsible for any injury, damage, or cost caused by or to “Member” with respect to any person or property. All property losses, including damage to private property, vehicles, and/or personal injuries are the sole responsibility of “Member”. Submissions of claims for insurance reimbursement must be submitted by “Member” under their own personal or vehicular polic(ies). Any vehicle utilized within club events is required to be insured, registered, equipped with historical license plates, and equipped with an ABC ("tri-class" or "multi-purpose") fire extinguisher.
My electronic signature below indicates receipt and understanding of the disclaimer policy of “Organization” as it is outlined above. I understand that this policy is subject to change and if revised, a new policy will be posted and distributed to all members by “Organization”.
Your selection of "Yes" will represent your electronic signature.
*
Yes, I have read and understand the Notice of Disclaimer.
Submit
Please make checks payable to "AMCOMC".
Home
Application
Events
Newsletter
Member Sponsors
More
Club History
Member Vehicles
Member Videos
Restoration Tips and Related Links