Totem Classic Thunderbird Club of B.C.

                                                                        Membership Application for the Year 2010

                                                          New Member Renewing Member

            Name:__________________________________ Significant Other:____________________________________

                                                                                                               ( last / first) (last / first)

                              Birthdate: ________________________ Birthdate: __________________________

                                                                                             (day / month) ( day / month)

   Address: _____________________________________________________________________________________

City: ___________________________ Prov/State: __________________ Postal Code: ___________________

Home Phone: ____________________ CTCI Member: Yes No VTCI Member: Yes No

Number:___________________ Number:____________________

Thunderbird(s) Owned: Year:__________ Model:_____________ Color:_____________________

Year:__________ Model:_____________ Color:_____________________

Other Collector Cars:___________________________________________________________________________

____________________________________________________________________________

Optional Information

Business Phone: __________________________ Mobile Phone: ____________________________

Email: __________________________________ Wedding Anniv. Date: ______________________

( month / day / year)

Amount Enclosed: $_________________ Applicant Signature:_______________________________

Date: _____________________________ Received By: ____________________________________

Chapter #80 of the Classic Thunderbird Club International

----AND---

A member of the NW Region - Vintage Thunderbird Club International

Please Mail Application To: Totem T-Bird Club, 5942 - Parkside Place, Surrey, B.C. V3X - 2B6

Dues are $40.00 annually, payable on or before January 1st and delinquent on January 30th,

First time members applying mid-year pay $3.50 per month for the remainder of the year to a maximum of $40.00.

A partial year payment is not allowed for previous Totem Club members mid-year. Full dues only.

First time members please add a $10.00 initiation fee (this is a one time only fee) to cover your nametags.

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Receipt

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