Membership Application
        Minuteman Chapter of Buick Club of America (BCA)

                http://www.minutemanbuick.citymax.com

                           Please print this application AND complete legibly.

TODAY'S DATE __________   NEW MEMBER ____ OR  RENEWAL ____

NAME (S) ___________________________________________________

ADDRESS___________________________________________________

CITY, STATE & 9-DIGIT ZIP______________________________________

10-DIGIT PHONE ______-______-________  CELL _____-_____-_______

YOUR EMAIL ADDRESS ______________________@________________

NEWSLETTER DELIVERY VIA:   EMAIL _____    OR    POSTAL MAIL ____

YOUR CURRENT COLLECTOR CARS  (Please list your Buicks first)

YEAR          -          MAKE          -          MODEL          -          BODY STYLE

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_____________________________________________________________

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Your BCA Membership Number: _______   BCA Expiration Date___________
   [ Membership in the BCA is a prerequisite for membership in our chapter, 

   but you can join us now and then IMMEDIATELY join the BCA by visiting
   their website at https://www.buickclub.org for membership information.]

 

Our chapter dues is $20 per calendar year.

Send completed form & check payable to "Minuteman Chapter, BCA" to:

AL DANN, Membership Secretary 

MINUTEMAN CHAPTER, BCA 

194 OXBOW ROAD, WAYLAND, MA  01778

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********** Updated December 10, 2018  **********