Totem Classic Thunderbird Club of B.C.
Membership Application for the Year 2008
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
A member of the NW Region -
Vintage Thunderbird Club International
PLEASE PRINT APPLICATION and Mail To: Totem T-Bird Club, c/o Registrar Lin Walker 2348 - 168th Street, Surrey BC V3S 0B5
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.
E-mail my newsletter in color please! [PDF Format]____ or Send my newsletter via Canada Post ___
Receipt Number
