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CLUB "T" MG MEMBERSHIP APPLICATION

Annual family membership $25.* Please complete the form and send with a check to Club 'T' MG, P.O. Box 5243, Portland, OR 97208.

DATE _________________

NAME ________________________________________________
(LAST NAME FIRST; PLEASE PRINT)

SPOUSE ___________________________________

CHILDREN _______________________________________________________

ADDRESS ________________________________________________________________

CITY ______________________________ STATE ___________ ZIP ______________

PHONE ( _ _ _ ) ________________ OCCUPATION (optional) _____________________

E-MAIL ___________________________________________________

CAR YEAR & MODEL _________________ COLOR _______________

LICENSE NUMBER _________________ CAR NUMBER ____________

CAR YEAR & MODEL _________________ COLOR _________________

LICENSE NUMBER _________________ CAR NUMBER __________

List additional cars on back.

*Calendar Year. Pro-rated as follows: April - June $20.00; July - August $15.00; Labor Day - ABFM special $25 through next year.

Date rcvd Treas. __________ Check#__________ Amt. __________

Date rcvd Membership __________



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