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


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 )