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