The WPC Club, Inc.     Mopar
             Plymouth, Dodge, Fargo, DeSoto, Chrysler, Imperial, Maxwell, Chalmers,  
Jeep and Eagle & related Automobiles.     All Mopar /  All Years /  All Models  
  
                                                
Join the WPC Club  
                        
WPC Club, Box 3504, Kalamazoo, MI 49003-3504

This Form is Interactive  -   Fill it out on your keyboard, print it and mail it in.
or  If you want to pay right now,  SECURELY on line go here
If paying by credit card you can also fax this to 269-694-2818 (Michigan). 

Check One:  ( * )       New Membership      or      Renewal           
( fields marked with an *  are required )

 First Name( * ) : Last Name( * ) :

 Spouse / Partner  
Street Address (
* )
 Address Line 2      

City ( * ) :   State / Prov. ( *) if applicable ):    
                    
Country ( * ) : Zip / Postal Code ( * if applicable ) 

 E-Mail:   Phone 
       Fax

Dues Schedule  ( Dues include yearly subscription to our publication,  the WPC News )    
Membership includes immediate family members.
      All funds are in US Dollars.
       

                    

USA, Only                             :       1 year $40.00  
USA Only First Class Mail:       Yearly $60.00          

Canada / Mexico :                       1 Year $42.00


Overseas /Foreign:                     1 Year $45.00

Overseas Foreign Air Mail:       1 Year $72.00     

  If you are outside of the USA Please pay by Credit Card as our bank charges $10.00 to process all Non-US Checks.


Method of payment in U.S. Dollars   (indicate one):   Check
Money order
Checks and Money Orders  must be in US Dollars.
                                             Visa Master card Discover card Amex
                                                                                
Credit Card Number:        
Expiry Date m/y Name on Card  ( *    security code on rear( * )


Signature ( for credit card auth.) ____________________________________________________

Chrysler Products Owned if applicable (  Please list Year, Make, Model, Body Style )