Membership Application

(Applicants must be at least 18 years old . All memberships are due and payable at the first of each year.)
* Required Fields

*
Membership Categories:
Regular $25.00 Member may participate in all planned club activities & receives merchant discounts
Family $30.00 Reserved for any two people legally related, residing at same address, receives same benefits as “Regular”
Associate $25.00 Reserved for anyone who does not have a Datsun/Nissan “Z/ZX, Roadster, 510” yet but has an interest for them -OR- has a different model Nissan than listed (ie 240SX, Maxima etc.). Member may participate in all planned club activities & receives merchant discounts, but does not have voting privileges.
*Status: New
Renewal: *Member#
*T-Shirt:
One free with membership
T-Shirt:  XL  XXL Additional t-shirts will available for purchase here.
Primary Member Secondary Member
*First Name: First Name:
*Last Name: Last Name:
*Email: Email:
*Address: *Phone: (xxx-xxx-xxxx)
*City: Hm#:
*State:
(ex. FL)
Wk#:
*Zip Code: Cell#:
Occupation:
Birthday: (mm/dd)
Model Year (xxxx) Color
Car 1:
Car 2:
Car 3:
Car 4:
Areas of Interest (please select all that apply)
Racing Touring Tech Support Rallies Social Activities Restoration Other
How did you learn about us?
Z Magazine Website Facebook Member Other
Comments
Disclaimer: Although it is SunCentral Z Car Club’s intention for all members to enjoy the outings and events of SunCentral Z Car Club, members should understand that all events are done at your own risk. The club, Officers and its Directors will not be held responsible or liable to any damage or injury sustained at any event or activity to any person(s) or car(s) participating. While it is a primary objective of SunCentral Z Car Club to distribute technical information via our monthly email newsletter “ZBlast”, club website, club Facebook page, technical discussion or sessions – any maintenance technique or possible modification published, taught or discussed should be weighed against conventional, traditional and generally accepted techniques or modifications and advised by a professional. SunCentral Z Car Club should not be considered the authority on maintenance or improving Datsuns/Nissans and the views expressed are those of the author, article, or person(s) quoted. Any modifications possibly affecting emissions or safety is the sole responsibility of the person performing them and when possible modifications are presented, it is with the understanding that they will be used for racing and not on public roadways. SunCentral Z Car Club shall not be held responsible for any adverse effects of any one following any information provided by our monthly email newsletter “ZBlast”, club website, club Facebook page, Club Officers, Technical Advisors or any club member. The mention of a product, service or procedure herein does not constitute endorsement of it, the club, its officers or its directors. Advertisement of products or services in the email newsletter or the club website does not necessarily imply recommendation or approval by SunCentral Z Car Club. “Remember to Buckle Up” and ENJOY THE RIDE!
Please sign (Type your name) and date below: I/We have read and understand clearly the disclaimer above as becoming member(s) or participant(s) of the SunCentral Z Car Club.
*Primary Member Signature *Date
(mm/dd/yyyy)

Payment options will be offered after submitting this form.

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