Electric Auto Association (EAA)
Membership Application
New Member: ________ USA: ________ Note: EAA membership dues are Renewal: ________ Canada: ________ tax deductible in the USA Other Country: ________ as allowed by the IRS. Date: ____/____/____ Name: _________________________________ Company: _______________________________ Street: _________________________________ Phone: Hm-_____________ Wk-___________ City: _________________________________ Fax: _______________________________ State: ______________ Zip: ____________ Country: _______________________________ If a new members, where did you hear about the EAA ? _______________________________ EAA Chapter you attend or support: _____Sacramento__________________________________ I need chapter information: _________ ================================================================================== Membership / Vehicle Information -- Please complete if new or changed ================================================================================== Please identify your primary areas of interest relating to the EAA. (Please rank your choices with a "1" being most important, "2" second, etc.) 1: _____ Hobby / Builder 2: _____ Professional (EVs are a source of income for you) 3: _____ Competition (Rallies, Races, and Records) 4: _____ Environmental and Government Regulations for EVs 5: _____ Social (Rallies, Shows, Dinners, Other) 6: _____ New Technology and Research 7: _____ Promotion and Public Awareness of EVs 8: _____ Student or General Interest 9: _____ Electrathon / Bicycle / Off-road Vehicles 10: _____ Owner / Driver of Electric Commute Vehicle 11: _____ Other: Please Specify: ________________________________________________ Number of EVs you ever owned ?: __________ Number of EVs you now own ?: _________ Please describe any Electric Vehicles you now own or are building: (if more than one, attach information on each) Vehicle Lic#: ______________ State: ____________ Country: _______________________ Vehicle Type: ______________ Make/Model: _________/__________ Model Year: ________ Converted Yr: ______________ Number of Wheels: __________ Motor Type: ____________ Controller Type: ___________ Batteries: No./Type: ____/_________ % Completed:_____ Pack Voltage: ______________ Avg. EV Mi./Week: ________ Avg. EV Trips/Week: ______ Other Features: ____________________________________________________________________ Comments: __________________________________________________________________________ __________________________________________________________________________ Please make your check or money order for $39 ($45 International)(US funds only) payable to the Electric Auto Association. Fasten it to this form and mail it to - Electric Auto Association 2710 St. Giles Lane Mountain View, CA. 94040 USA Note: All information and statistices in this application are for the exclusive use of the EAA. This form was printed from The Sacramento EV Association HomePage located at http://saccityweb.com/seva/index.html