SAMOA Membership Application Form
Member #1 Name *

First
Last
Member #1 Birthday *

MM 		/
DD 		/
YYYY
Member #2 Name

First
Last
Member #2 Birthday

MM 		/
DD 		/
YYYY
Address *

Street Address

Address Line 2

City
State / Province / Region

Postal / Zip Code
Country
Email *
Phone Number *

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Miata #1 Year, Color and [optional] Name *
Miata #2 Year, Color and [optional] Name
Miata #3 Year, Color and [optional] Name
Type of Membership *
 Paid Membership ($24/year) 
 Free First Year membership 
If applying for a free membership, I affirm that I am not a former SAMOA member, and that I have purchased my Miata in the current calendar year.
 Correct 
Date Submitted *

MM 		/
DD 		/
YYYY
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Annual paid membership dues are $24 per
year.  Please mail your check, payable to
SAMOA, to SAMOA Membership, 1864
Bridge Creek Drive, Sacramento, CA 95833.

Free memberships are limited to those who
have never been SAMOA members before,
and who have purchased their Miata in the
current calendar year.  This offer will expire
after 12 months of membership, at which
time annual dues will be assessed $24 per
year.

Membership automatically places your
information on our club roster, which is
password protected and can only be viewed
by other SAMOA members.

Your information will never be shared with
vendors or any other outside parties without
your expressed written permission.

Please address any questions you may have
to our Club Secretary.
Prospective SAMOA Members
Please review to following
before submitting your application
Copyright 2006 - 2011 • Sacramento Area Miata Owners Association • Sacramento, CA 95833
Privacy Policy • For questions about this website please contact the webmaster
MEMBERSHIP
APPLICATION
The Sacramento Area Miata Owners Association
1864 Bridge Creek Drive - Sacramento CA 95833
www.sacramentoareamiata.org