Thank you for your interest in the Mt. Hood Miata Club. We offer two methods for you to submit your application and dues for membership. Please complete the form below, and follow the instructions at the bottom of the screen for your submission options.

Please complete as many fields as you can. Fields marked with an *asterisk
are required.

*First Name:
*Last Name:
*E-mail address:
Birth Date:	mm/dd
Significant Other First Name:
Significant Other Last Name:
Significant Other E-mail address:
Significant Other Birth Date:	mm/dd
Wedding Anniversary Date:	mm/dd
*Street Address:
Street Address:
*City:
*State:
*Zip:
Home Phone #:	###- ###- ####
Cell Phone #:	###- ###- ####
Work Phone #:	###- ###- ####
Newsletter:	How would you like to receive our newsletter?
	E-Mail US Mail Both
Info about Your Miata(s)
Year:	89 90 91 92 93 94 95 96 97 99 00 01 02 03 04 05 06 07 08 09
Color:
Plate #:
Car Nickname:
Modifications:
Year:	89 90 91 92 93 94 95 96 97 99 00 01 02 03 04 05 06 07 08 09
Color:
Plate #:
Car Nickname:
Modifications:
Year:	89 90 91 92 93 94 95 96 97 99 00 01 02 03 04 05 06 07 08 09
Color:
Plate #:
Car Nickname:
Modifications:
Comments:

Please review all entries. It is important that you complete all of the required fields.

We offer two options for the submission of your application and dues.

 

Submit your application electronically and pay now with Use this option if you want to electronically submit your application and pay now online using your checking account or credit card.

Print your application and mail. Use this option if you want to print a paper copy of your application and mail it along with your check for $30.00 to: Mt. Hood Miata Club Membership P.O. Box 396 Portland, Oregon  97207

Thank You!