Union County Antique Tractor & Power Club

New Member Application

NAME___________________________________________________________

MAILING ADDRESS_______________________________________________

CITY_________________________ STATE_____________ ZIP____________

TELEPHONE NUMBER ______________(HOME) _____________(BUSINESS)

E-MAIL ADDRESS (optional) ________________________________________

NAME OF EMPLOYER / BUSINESS: __________________________________

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How did you hear about the club?___________________________________________

Would you help with fund raising ?________YES     _______NO                                       

Are you interested in serving on any of the committees ? _______ YES   _______NO     

What are your interests / hobbies ? _________________________________________

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COMMENTS: __________________________________________________________

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SIGNATURE: ________________________________ DATE: ____________________

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Membership  approved by club ? _____ YES     _____ NO          DATE _____________