DKW Club of America
                       Founded 1989

  Membership Secretary:  Robert Paul
                                       4406 Bridle Road.
                                       Bartlesville, OK 74006
                                       USA
                                       (918) 333-5182                email: alcoc628s@yahoo.com
 

Name: (Mr. Mrs)

Street/P.O.Box:

City:                                                                                         State:

Mail Code:                                                                             Country:

Phone: Home:                                              Work:                                                    FAX:

E-Mail:

May we publish your address and phone info in Club listings and registers?_______________________

Please provide information on your Auto Union vehicles below: (indicate "P" for parts vehicles)
 

Vehicle 1	Vehicle 2	Vehicle 3	Vehicle 4
Year:	Year:	Year:	Year:
Make:	Make:	Make:	Make:
Model:	Model:	Model:	Model:
License:	License:	License	License:
State:	State:	State:	State:
Chassis No:	Chassis No:	Chassis No:	Chassis No:

Please read the following and be sure to sign below.  This is necessary to process your application for membership in the DKW Club of America.

IT IS THE POLICY OF THE DKW CLUB OF AMERICA THAT ALL VEHICLES DRIVEN AT CLUB EVENTS MUST CARRY LIABILITY AND PROPERTY DAMAGE INSURANCE COVERAGE.  I AGREE TO CARRY INSURANCE TO COVER ME AND MY GUESTS IN THE EVENT OF ACCIDENT OR INJURY ARISING IN CONNECTION WITH ANY CLUB ACTIVITIES.  I FURTHER AGREE THAT THE OFFICERS AND MEMBERS OF THE CLUB SHALL HAVE NO LIABILITY TO ME OR MY GUESTS, AND I AGREE TO INDEMNIFY, DEFEND AND HOLD THEM HARMLESS FROM ANY CLAIM AGAINST THEM ARISING SOLELY BY VIRTUE OF THEIR STATUS AS AN OFFICER OR MEMBER OF THE CLUB.

Signature_______________________________________________ Date_________________

Please complete this application and return with your check (US Funds only) for annual dues of $17.00 USA, Canada and Mexico, $23.00 for all other countries, to the Club address above.  Welcome aboard!