Potomac Chapter, Studebaker Drivers Club

Membership Application/Renewal

Please complete this form, enclose a check for $15.00 payable to Potomac Chapter SDC, and mail to:

Nadine Farris
4313 Landgreen St.
Rockville, MD 20853

Your first name: ____________________________ Your spouse's first name:________

Your Last Name:________________________________________________________

Your Street Address:_____________________________________________________

Your City, State, and Country (if other than US)________________________________

Your Zip or Postal Code:__________________________________________________

Your Telephone number(____)_______-__________________________________

Your E-mail address:____________________@___________(please copy carefully)

Your fax number(______)______-____________________

Your Birthday (month and Day only)______________________________*

Your Spouse's Birthday (month and day only)_______________________*

*Dates are used only for birthday greetings in the Commander.

Is this a Potomac Chapter Membership renewal___________or new application___?

Are you a National SDC member? (Yes or No)

Cars owned including:

Year:_____________ Make:____________ Model:__________

Body Style:_________ Comments:_________