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New Membership Signup Form

*Dues: $20.00 per year, payable annually in January.

Name / Spouse*
Address*
Street Address Address Line 2 City State ZIP Code
Home Phone
Cell Phone
Vehicle(s)
Year Make Model

Tell us about your car or truck.
Are you on Facebook?
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- No
Are you a member of POCI Int'l?
- Yes
- No
Email*
How many wheels on a car?*
Please enter a number from 1 to 10000.
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