Union County Antique Tractor & Power Club

New Member Application

Name____________________________________________________________________

Mailing Address____________________________________________________________

City________________________________ State________________ Zip______________

Telephone Numbers                                                                                          
                                                                                                           
 ____________________________(HOME)  ___          Please indicate the number  where 
                                                                           you would prefer to receive
 ________________________(BUSINESS)  ___          calling post notifications.                  
                 
____________________________(CELL)   ___                                                                   

E-MAIL ADDRESS (optional) ________________________________________________

Would you prefer to receive the Club's newsletter by   e-mail ___ or  US Postal mail ___?

Name of Employer/Business__________________________________________________

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 ? ____________________________________________

_________________________________________________________________________

COMMENTS: _____________________________________________________________

_________________________________________________________________________

SIGNATURE: ___________________________________ DATE: ____________________

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Membership  approved by club ? _____ YES     _____ NO          DATE _____________