Membership Application Form

Complete this form, print it out, enclose your payment, and mail it to:
SSCC, P.O. Box 420, Ely, Nevada 89301
Make your check or money order out to: SSCC, Inc.

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Date:
First Name:
Last Name:
Address:
City:
State:
Zip Code:
Country:
Phone#:
Fax#:
E-Mail:
Car Club Affiliations:
Car Make, Model, Year:

Has Your Address Changed? Yes No

Annual Membership: $25.00 Enclosed

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Lifetime Membership $200.00 Enclosed:
Requested Car Number

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