CENTRAL OKLAHOMA VINTAGE TRIUMPH REGISTER MEMBERSHIP APPLICATION
PLEASE PRINT

 NAME: _____________________________________________________________________
                                     (LAST)                          (FIRST)                         (M.I.)

 SPOUSE/COMPANION: ________________________________________________________

 ADDRESS: __________________________________________________________________

 CITY: ______________________________ STATE: __________ ZIP: __________________

 PHONE (HOME) _______________ (WORK) ________________ (FAX) _________________

ARE YOU JOINING AS: ( ) DUAL MEMBERSHIP ($25)             ( ) SINGLE MEMBERSHIP ($15)
                                  ( ) RENEWAL, DATE JOINED: _______________________

 TRIUMPHS OWNED:                 MODEL              YEAR            COMMISSION #              CONDITION

                        AUTO #1:          ______________________________________________________

                        AUTO #2:            ______________________________________________________

                        AUTO #3:            ______________________________________________________

                        AUTO #4:            ______________________________________________________

            CONDITION CODE:            O=ORIGINAL, R=RESTORED, B=BEING RESTORED, P=PARTS CAR

 SPECIAL INTERESTS (CHECK ALL THAT INTEREST YOU)
( ) SHOWING                 ( ) RESTORATION               ( ) DRIVING & TOURING
( ) ADMINISTRATION      ( ) AUTO CROSSING            ( ) RACING

 ARE YOU CURRENTLY A MEMBER OF ANY OF THE FOLLOWING:

VINTAGE TRIUMPH REGISTER: _____________  IF SO, VTR MEMBER #: ______________________

SIX PACK CLUB: _______________ TR8 CLUB: ________________ SPORT SIX: ________________

TRA REGISTER: _______________  OTHER CLUB: ________________________________________

MAKE CHECKS PAYABLE TO C.O.V.T.R.
MAIL TO: TREASURER, Bill Gingerich
                           18600 Andrew Ln
                            Newalla, OK 74857-8774
__________________________________________________________________________

THE VINTAGE TRIUMPH RESGISTER
Dues: $25 per year
Send to: VTR – Membership – 15218 W. Warren Ave. – Dearborn, MI  48126  U.S.A.

NAME: ____________________________________ SPOUSE: _______________________________

STREET ADDRESS: ______________________________________ TELEPHONE: ________________

CITY: _______________________________ STATE: _____________________ ZIP: _____________

TRIUMPHS OWNED:                        MODEL              YEAR            COMMISSION #              CONDITION

                        AUTO #1:          ______________________________________________________

                        AUTO #2:            ______________________________________________________

                        AUTO #3:            ______________________________________________________

                        AUTO #4:            ______________________________________________________

            CONDITION CODE:            O=ORIGINAL, R=RESTORED, B=BEING RESTORED, P=PARTS CAR