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Your annual membership dues are $24.00. Please provide the following information, enclose a check for your
membership dues, and send to SAMOA, Att: membership, 1864 Bridgecreek Drive, Sacramento, CA 95833. If you
have any questions please contact Pamela Hunt at rspjhunt@sbcglobal.net.
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Please Complete All Of The Applicable Fields Listed Below
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Member #1:
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Member #2:
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Name:
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Name:
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Birthday (mo/date):
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Birthday (mo/date):
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Street Address:
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City, State, Zipcode:
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Telephone Number:
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Email Address:
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Miata #1:
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Color:
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Year:
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Name:
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Miata #2:
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Color:
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Year:
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Name:
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Miata #3:
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Color:
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Year:
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Name:
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Membership automatically places this information on the club roster, which can only be viewed by other SAMOA members.
Your information will never be given to vendors or other third parties without your expressed written permission.
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If complementary membership, enter date/city of purchase:
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Date Submitted:
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Amount Paid:
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If your first year membership is complementary, please
mark COMP in the Amount Paid box above.
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