Print this form, complete and return with dues payment to the address indicated.

 
BUCKEYE TRIUMPHS
9023 Concord Road
Johnstown, OH 43031
E-mail questions to:
vanordergj@embarqmail.com
MEMBERSHIP DATA REQUEST  Membership includes spouse.    List  additional  vehicles and club affiliations on back of form.   
Last Name  
First Name(s)  
Address  
City  
State/Province   
Zip/Post Code  
E-mail  
Phone, Home (          )
Phone, Work (          )
Fax (          )
I am currently a member of:
checkbox.jpg (747 bytes) Vintage Triumph Register (VTR)
checkbox.jpg (747 bytes) 6PACK
checkbox.jpg (747 bytes) Triumph Register  of America (TRA)
checkbox.jpg (747 bytes) TR8 Car Club of America (TR8CCA)
checkbox.jpg (747 bytes) Triumph Digest
checkbox.jpg (747 bytes) Central Ohio Chapter TRA (COCTRA)
checkbox.jpg (747 bytes) North Coast Triumphs
checkbox.jpg (747 bytes) Miami Valley Triumphs 
checkbox.jpg (747 bytes) Other ______________________
checkbox.jpg (747 bytes) Other ______________________
checkbox.jpg (747 bytes) Other ______________________
Triumphs Owned Model/Year/VIN/etc.
Vehicle 1  
Vehicle 2  
Vehicle 3  
Vehicle 4  
Vehicle 5  
Dues are $20/Year (Includes Spouse)
Date
Dues Paid
Signature
 
 
 
checkbox.jpg (747 bytes) Do not release data outside club membership
  Rev. 11/06/07

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