Online Membership Application

Member Information

TIP: use your tab key to move to the next field

             First name:     Last name:

Spouse/S.O. name: (Optional)

      Street address:

                        City:   State:     Zip:

                  Country:     Phone:

      E-Mail address:     Web site address: (Optional)

Message Board nickname (if you have one, if you do not have one you will need to create one yourself. One will not be created as part of the application process):     Birthday (MM/DD):


How did you find us?:    Internet Search     Referral from friend     Referral from dealer     Card on windshield     Other
If you checked "Other" on the above line, please describe how you found us:

Member Directory
The Club's online Member Directory, which is accessible ONLY to members with a valid password, lists the following information for each member: name, city, email address, and web site. If you do NOT want some of this information listed, check the boxes below as desired. Otherwise skip this section.

Do not list name    Do not list e-mail    Do not list city    Do not list web site    Do not list Message Board nickname

About Your 300M
If you are a 300M Enthusiast but don't yet own one, check this box and skip the rest of this section.

     Model year:

Exterior Color:    Click here to find your paint code. A new browser window will open.

 Interior Color:     Wheels:

Factory options (check all that apply):
300M Special Performance Handling Group      360 Watt/11 Speaker Stereo Upgrade

Luxury Group      Sunroof      Full-size spare/matching rim

Cold Weather Group      Smokers Group      Front Seat Side Impact Airbags

Other accessories or modifications to your 300M:




Dues Payment
Dues are $14.95 (U.S. funds) for a 12 month membership (spouse or S.O. included).
You may pay by check, or you may pay online using PayPal and your own credit card, in a secure transaction (have your credit card info handy).

Please indicate your preferred method of dues payment:     PayPal      Personal check (no money orders please)

After you click on "Submit", you will be taken to a page that has the address to mail your check (if you chose that option) and a link to the online PayPal payment (if you chose that option).

    

CHRYSLER®, 300M®, and the 300M & Design® logo are all registered
trademarks of DaimlerChrysler Corporation. This club and this
web site are not affiliated in any way with DaimlerChrysler Corporation.