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Printable Membership Application Form
Last Name:___________________________________ First Name:_______________________________ E-Mail: _______________________________________ Spouse: ________________________________ Occupation: ___________________________________________ Address: _____________________________________________________________________________ City:_____________________________________________ State: _______ Zip: ___________________ Province (if other than US): ______________________________________________________________ Country (if other than US): _______________________________________________________________ Home Phone:______________________________ Work Phone:_________________________________
For renewals please specify your existing membership number (if known) __________________
You may list up to 4 Model T’s that you own: Car 1: ________________________________Car 2:______________________________ Car 3:_________________________________Car 4: _____________________________ Note: We normally include membership information on our club roster which is never sold or used for non club purposes. You may still request that we not put your information in the printed roster by answering yes or no below: Include my information in the club roster ________ (yes/no) 1 Year Individual or Family Membership Dues: U.S.…………………………………$35.00 Foreign Countries……………………$40.00 (In US funds drawn on a U.S. Bank) Individual Life Membership….....………$600.00/$700 Intl Make checks payable to: Mail to: M.T.F.C.I. PO Box 355 Note: Customer Credit Cards can be accepted by using the online application Form, to use the online process click here Please enter the following information if you would prefer to use VISA or MasterCard: Please bill my VISA or MasterCard for ______________ (amount) Card Number: __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ Expiration Date: ____________ Signature ___________________________________ |
