CENTRAL ILLINOIS CRUISERS
            CAR CLUB, INC.
          MEMBERSHIP FORM 2016

Dues:  $10.00

Benefits to becoming a Member of the Central Illinois Cruisers, Inc.:
                            • Membership card
                            • Window Sticker
                            • Chance to have your car placed on T-Shirt
                            • Helps keep the car club running (website, fliers, signs, etc...)

Name:_______________________________________

Address:_____________________________________

City:__________________ST:______Zip:__________

Phone:__________________  Cell:________________

E-Mail:______________________________________
Car/Truck Info:

Year:_____Make & Model:____________________________Color: ____________
Any other Cars/Trucks
Year:_____Make & Model_____________________________Color:____________

Year:_____Make & Model_____________________________Color:____________

 If joining by using paypal above please print off this form and bring to cruise-in to confirm payment and pick up membership card and sticker!
Or copy and paste this form and email us
click here to email us

make checks payable to: Central Illinois Cruisers
Please return form and dues to Amanda or mail to:
Central Illinois Cruisers
4719 N. Edgebrook Dr.
Peoria, IL  61614