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 ______________________________________________