CLASSIC THUNDERBIRD CLUB INTERNATIONAL
1308 E. 29th Street, Signal Hill, CA 90806 USA
Telephone: 562-426-2709

MEMBERSHIP APPLICATION

PLEASE TYPE OR PRINT

Name_____________________________________________Spouse's Name______________________

Mailing Address_____________________________________________________________________

City_____________________________________________State_____________Zip_______________

Phone No.____________________________ Email Address_________________________________

How many Thunderbirds do you own?________55's________56's________57's

New members please fill out application and send payment in U.S. funds ONLY to the address below.
Make checks payable to: CTCI or Classic Thunderbird Club Int.
Please select one of the following payment schedules. Annual dues renewal will be $32.50, 
payable January 1 and delinquent February 1.
		CLASSIC THUNDERBIRD CLUB INT., 1308 E. 29th Street, Signal Hill, CA 90806

    FEE SCHEDULE             INITIATION FEE     +    DUES     =    TOTAL
[ ] January thru March .......... $15.00        +   $32.50    =    $47.50
[ ] April thru June ............. $15.00        +   $24.75    =    $39.75
[ ] July thru September ......... $15.00        +   $16.50    =    $31.50
[ ] October thru December ....... $15.00        +    $8.25    =    $23.25

    Postage: Canada & Mexico (ONLY): First Class ............ Additional  $15.00
    Postage: ALL Other Foreign Countries: A/O Rate .......... Additional  $20.00


Signature ________________________________     Date _____________________

Do you wish to be listed in the CTCI roster, as of April 1st?  [ ] Yes    [ ] No

Are you a former member of CTCI? [ ]Yes  [ ]No   Former CTCI # _______

Sponsored or Referred by Jerry Wotel       CTCI # 6597



___________________________________________________________________________
For Office Use Only
Number_____________________________________ Date___________________________ Ck.#_______________________________________ Amount_________________________

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MEMBERSHIP INFORMATION

Please provide the following data to establish current and accurate membership information for the CTCI
computer database. Basic Information will be used for mailing labels, rosters, and renewal status. Optional
data may be used to develop statistical information such as membership profiles. Only authorized CTCI
office personnel will have access to this data. Release of ANY data and information will require approval
of the CTCI Board of Directors.

                                                                   CTCI # _____________

Last Name ______________________________ First Name _________________________ Middle ___________________

Title (Jr., MD., etc) __________________ Spouse ________________________________________________________

Street Address _________________________________________________________________________________________

City _______________________________ State/Province ___________________ Zip/Mail Code __________________

Country ____________________________ Phone ______________________

Occupation (Optional) __________________________________________________________________________________

Do You Wish Your Name to Appear in the Annual Roster?   [ ] Yes    [ ] No

CTCI Chapter Affiliation (if any) __________________________________________ Office Held _______________

Applicant Birthdate (Opt.) ________________________ Spouse Birthdate (Opt.) ____________________________

Business Address (Opt.) ________________________________________________________________________________

City _______________________________ State/Province ___________________ Zip/Mail Code __________________

Country ____________________________ Phone ______________________

CAR DATA

This data will be found on the fire wall, inside the engine compartment; left hand side by the heater box. Please fill in the number and letters as stamped on the data plate. Serial Number _______________________________________________ For 1955, 1956, and early 1957's Body _________ Color __________ Trim ___________ Production Code ______________________ For late 1957's Body _________ Color __________ Trim ___________ Date ________ Trans ______ Axle ______ Registered Owner (if other than above) ________________________________________________ Address _______________________________________________________________________________ License Number __________________ State/Province ______________ [ ]Original [ ]Modified Color (if not per data plate) __________________________ Condition (10 is best) ________ Mileage _______________ Special Features or Remarks ____________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________