Spouse/Partner: _______________________

Address: ___________________________________________________________

City: _______________________ State: __________ Zip: __________

Phone: (_____)__________________    E-Mail: ______________________________________

Cell: (_____)__________________        FAX: (_____)__________________  

Birthdays/Anniversary (month and day only - we don't need to know the years!)

Applicant: _________ Spouse: _________ Anniversary: _________

I own the following Thunderbird(s):

_____ 1955 Color: _______________________________________

_____ 1956 Color: _______________________________________

_____ 1957 Color: _______________________________________

_____ Other Year: __________        Color: _______________________________________

_____ None at present

Although not a requirement for Chapter membership, we urge each member to be a member of CTCI.

I am _____ / am not _____ a member of CTCI. My CTCI number is __________.

Membership Requirements:

Prompt payment of annual dues.

Hosting a club meeting on a rotational basis.

(Approximately once every three years. The cost of refreshments is the member's responsibility.)

Chapter dues are $36.00 per year, or $10 per quarter. Make checks payable to NJORTC. (Dues will be prorated, on a quarterly basis, for new members.)

Signature _______________________________________ Date ___________