Vintage Triumphs Of Wisconsin Membership Application

Today’s Date: ________________________

Name:_________________________________________ (First M.I. Last) Birthday: ___/___

Spouse or SO:__________________________________ (First M.I. Last) Birthday: ___/___

Address:____________________________________________________________________

City:______________________________________________State_______Zip____________

Home Phone: (_____)___________________Work Phone: (_____)____________________

Fax: (_____)___________________________e-mail: ________________________________

For Club Information, please fill in the information below- Triumphs and other special interest cars presently owned:

Please list any additional cars or information on a separate sheet of paper. Enclose photographs of Triumphs presently owned. These will be scanned for club records and promptly returned to you. Clearly write your name and address on the back of each photograph. Please indicate what you would like to appear on your VTOW Name Badge: Name ____________________________________ (First or Nickname & Last)

2nd Line _______________________________________ (Triumph Model or Your Town)

Please print out and include your check for $25 made out to "Vintage Triumphs of Wisconsin", fold form and tape edges to secure check, add a first class postage stamp and mail to Vintage Triumphs Of Wisconsin c/o Keith A. Bay, W302 N6545 Beaver View Rd., Hartland, WI 53029-9220.