PCA 914 Special Interest Group Registration Form

NOTES: Please fill out and submit a separate form for each car.
             If you have no data for a field, leave it empty!

DRIVER

First Name  OK To Publish?
Initial  (don't put a period after the initial)  OK To Publish?
Last Name  OK To Publish?
Nickname
  OK To Publish?
Spouse Name  OK To Publish?
Address  OK To Publish?
City  OK To Publish?
ST  (use two-letter, all-caps abbreviation, such as "TX")  OK To Publish?
ZIP  OK To Publish?
Country  OK To Publish?
Home Phone  (don't use non-numeric characters)  OK To Publish?
Work Phone  (don't use non-numeric characters)  OK To Publish?
Ext.
  (don't use non-numeric characters)  OK To Publish?
Mobile Phone  (don't use non-numeric characters)  OK To Publish?
Fax  (don't use non-numeric characters)  OK To Publish?
E-mail  OK To Publish?
Occupation  OK To Publish?
PCA #  (it's on your Pano mailing label...)  OK To Publish?
PCA Region  OK To Publish?
CAR
List My Car in the  Register
Year  (use all 4 digits, e.g. "1974")
Engine Displacement  (use "1.7", "1.8", "2.0", etc, not "1971cc")
Number of Cylinders
Chassis #  (on a tag on your left windshield post...picture...)
Engine #  (on 2.0L, near the oil filler...picture...)
                                                    (on 1.7/1.8L, near top back, under FI stuff)
                                                    (on 914/6, on top of the case, near oil breather)
Transmission #
Color (Color Chart...)
Color Code  (the bottom # on a plate near the left door hinges...picture...)
Karmann #
  (the top # on the same plate that the color code is on...)
Interior Color
Brand/Type of Wheels
Options...
Front Bar?
Rear Bar?
Center Gauges?
Vinyl Sail Cover?
Front Fog Lights?
Chrome Bumpers?
Center Cushion?
Heated Rear Window?
Air Conditioning?
Leather Steering Wheel?
Leather Shift Boot?
Tinted Glass?
Passenger Side Mirror?
"PORSCHE" Side Script?
Rear Fog Light?
Center Seat Belt?
Modifications
History
Usage
914 Expertise
Other Car Clubs
Car Nickname
Car Gender
  (use "M" or F"...it's just for fun)

Is it OK to publish information fields which have a "Y" in the associated "OK to Publish?" 

We recommend that you obtain a Certificate of Authenticity, by writing PCNA. You can get complete
information about the Certificate of Information program here. Please send a copy to us.

In addition to the above information, we would like a small picture of your car, either via e-mail
or US mail (PO Box 213, Weatherford, TX 76086)...sorry, we can't return the picture.

NOTICE: The following "Submit" feature does not work properly for some people (like AOL users).
If you are of the AOL persuasion, please print this form and send via US mail to:
Charles Davis, PO Box 213, Weatherford, TX 76086. Or, alternately, copy it and paste it into an e-mail.

Otherwise, please e-mail the above completed registration form by clicking on this button...