VINTAGE & CLASSIC WHEELS OF G.I.

P.O. Box 424

Grand Island, NE 68802

NEW MEMBER APPLICATION

DATE:_________________

NAME:_____________________________________________________________________________

MAILING ADDRESS:__________________________________________________________________

__________________________________________________________________________________

SPOUSE NAME:______________________________________________________________________

PHONE NUMBER:_______________________ WORK PHONE NUMBER:_________________________

PLACE OF EMPLOYMENT:______________________________________________________________

TYPE OF AUTOMOBILES OWNED:________________________________________________________

___________________________________________________________________________________

BIRTH DATE SELF:________________________BIRTHDATE SPOUSE:__________________________

ANNIVERSARY:______________________________________________________________________

CHILDREN'S NAME & BIRTH DATE THAT ARE STILL AT HOME:_______________________________

__________________________________________________________________________________

__________________________________________________________________________________

OTHER CLUB AFFILIATIONS:__________________________________________________________

__________________________________________________________________________________

SPECIAL INTERESTS:_________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

WELCOME!

PLEASE PRINT OUT AND MAIL TO ADDRESS ABOVE WITH $10 DUES.

Thank You.