Membership Application

Vintage Triumphs Of Wisconsin Membership Application

Today’s Date: ________________________

Name:_________________________________________ Birthday: ___/___/___

First M.I. Last

Spouse or SO:__________________________________ Birthday: ___/___/___

First M.I. Last

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 print out, fold for, add First Class postage and mail to:

Vintage Triumphs Of Wisconsin

c/o Bob Gehweiler

W64N766 Washington Ave.

Cedarburg, WI 53012