APPLICATION
UPSTATE NEW YORK THUNDERBIRD CLUBplease print this page and mail in. |
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| Name __________________________________ |
Spouse_________________________________ |
| Address_________________________________ | City________________________State___________ |
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Zip Code_______________-__________ |
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| Month and Day of Birth _____ / _____(no year) | SpouseMonth and Day of Birth _____ / _____(no year) |
Phone (______) _________ - _____________ |
email address__________________________________ |
| Please list year & model of Thunderbird owned: | |
____________________________________________ |
____________________________________________ |
____________________________________________ |
____________________________________________ |
| Other Collector Cars Owned: | |
____________________________________________ |
____________________________________________ |
____________________________________________ |
____________________________________________ |
| Membership Dues: | Make check payable to: |
| Joining January through June: $20.00 | Upstate New York Thunderbird Club |
| Joining July through September: $10.00 | |
| Joining October through December: $20.00 | Send to: |
| (includes membership for following year) | Bill Kurrasch, Treasurer |
| Renewals regardless of month: $20.00 | 5607 Lincoln Road |
| All memberships expire on December 31 | Ontario, New York 14519 |