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WELCOME TO THE VINTIQUES

Any person of good character interested in Street Rodding Activities is eligible for membership. The initiation fee is a one time fee of $15.00 + $30.00 annual dues renewable by February 1st of each year.

 

PRINT CLEARLY

 

Name _______________________ Bday (m/d)__________ Hm Phone (______)_____________

Address__________________________________City_______________State _____ Zip ______

E-Mail-Address ___________________________________ Cell (______)__________________

Place of Business _______________________________________________________________

Occupation ______________________________ Wk Phone (______)_____________________

Hobbies or other interests _________________________________________________________

 

An Associate Member is a Spouse/SO (Significant Other) or Child (13-18) living in the home of a full member. It is not required a Spouse/SO or Child be an Associate to participate in Vintiques functions, however, it is required for him/her to have the right to vote or to be eligible to hold office on the Board of Directors. The annual fee is $10.00 per Associate due by February 1st of each year with no initiation fee.


Spouse/SO Name __________________________________ Associate $10 yes _____ no _____

Birthday (m/d) __________________________ Anniversary (m/d) _______________________

E-Mail Address ___________________________________ Cell (______)__________________

Place of Business _______________________________________________________________

Occupation _______________________________ Wk Phone (______)____________________

Hobbies or other interests _________________________________________________________

 

List Children under 18 living at home

 

Name ______________________________ B-day________ Associate $10 yes ______no______

Name ______________________________ B-day________ Associate $10 yes ______no______

Name ______________________________ B-day________ Associate $10 yes ______no______

Name ______________________________ B-day________ Associate $10 yes ______no______

 

List your Street Rods or Classic Autos

#1 Year _____ Make ________________ Model _______________________ Complete _____%

Circle all that apply: Streetable Used for Rod Runs Parades Car Shows Other_______________

#2 Year _____ Make ________________ Model _______________________ Complete _____%

Circle all that apply: Streetable Used for Rod Runs Parades Car Shows Other_______________

#3 Year _____ Make ________________ Model _______________________ Complete _____%

Circle all that apply: Streetable Used for Rod Runs Parades Car Shows Other_______________

#4 Year _____ Make ________________ Model _______________________ Complete _____%

Circle all that apply: Streetable Used for Rod Runs Parades Car Shows Other_______________

 

Who told you about the Vintiques ___________________________________________________

Reason for wanting to join the Vintiques ______________________________________________

Other Clubs or Affiliations ________________________________________________________

 

Return completed form and required dues to:
Nancy Baisinger, 5107 N. Sky Vista Ave, Yakima, WA 98901-4303 (509) 910-1148

 
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