Join Us

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) _____________________________________

                              _____________________________________

                              _____________________________________

                              _____________________________________

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_____________________________________

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