Waiting list form
Please complete form on computer & email to:
Linda Zimliki      lzimliki@westpennmiataclub.com 
                                                                                                                    





Name(s): 


Address:

City                                     State                              Zip

Phone: Residential                                        Cell
                                                                                        
                                                          Cell

Email Address:

Miata Club(s) Affiliation: 

Miata Information

Year                                   Color                                           License


When your form is received you will be notified of your position on the waiting list.