Three Rivers Model T Ford Club
P.O. Box 7083
Kennewick, Washington 99336
Membership Application
Date:_______________________
Name:_______________________Birthdate:Month_____Day_____
Spouse_______________________Birthdate:Month_____Day_____
Anniversary:Month_____Day_____
Children (under 18) _____________________________________
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Address______________________________ Phone_______________
City__________________________State________Zip_____________
e-mail address_________________________________
Cars
Ownership is recommended but not a requirement of membership
Condition code: OC (original condition) U (unrestored) PR (partially restored) FR (fully restored) SIAB (stored in apple boxes)
Year Model Condition code
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Yearly Membership Dues $20
Meetings 7:00 PM the third Thursday each Month at:
Riata Springs Baptist Church
2830 Leopold Lane, Richland, Washington
Membership in the Model T Ford Club of America is recommended and encouraged. MTFCA P.O. Box 126 Centerville, IN 47330
Applicant Signature_____________________________________