MONTANA CROSS COUNTRY T ASSOCIATION
1004 Sioux Road. Helena, MT 59602
Application For Membership
Date of Application ____________________________________________________________________
Name _________________________________________________________________________________
Address _______________________________________________________________________________
City ___________________________________________________________________________________
State __________________________________________________________________________________
Zip Code _______________________________________________________________________________
Occupation (optional) ___________________________________________________________________
Year and Body Style of Car _______________________________________________________________
Model T Ford Club of America membership number _________________________________________
Model T Ford Club International membership number _______________________________________
Phone Number __________________________________________________________________________
E-mail Address ___________________________________________________________________________
You will be put onto the mailing list to receive all letters concerning the club’s activities when you become a member of this association.
Dues are $10.00 per year.
This fee covers membership costs only and does not include the $35.00 entrance fee for the Montana Cross Country Model “T” Endurance Run or for touring with this event.
Please send check or money order payable to the Montana Cross Country “T” Association to the above address.
This club is not responsible for accidents.
____________________________________________________
Applicant’s Signature
