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                           Membership Application
                         THUNDERBIRD MIDWEST CLUB

NAME: ______________________________ BIRTHDAY: (mm/dd) _________

SPOUSE OR OTHER : ___________________BIRTHDAY: (mm/dd) _________

ANNIVERSARY: (mm/dd) _____________

ADDRESS:______________________________________________________

CITY/ STATE/ZIP _______________________________________________


E-MAIL ADDRESS:_______________________________________________

RES. PHONE ____________________ BUS. PHONE ____________________
 
Listed below are active committees.  If you have an interest in any of them, please indicate with a checkmark: (optional)
 
 ______ TELEPHONE CALLER         ______ NEWSLETTER EDITOR

 _____ GUEST SPEAKER COORDINATOR         _____MEETING LOCATIONS

 _____  WEBSITE COORDINATOR   

(OTHER POSITIONS ARE NOMINATED/ELECTED POSITIONS)

YEAR AND MODEL OF THUNDERBIRD(S) OWNED:

Year:________  Model_____________________________

Year:________  Model_____________________________

Year:________  Model_____________________________


OTHER SPECIAL INTEREST CARS: ___________________________________

The annual dues are only $25 and a full year runs                          from January 1st to December 31st. 
Send application and check to:

    Cliff Lieske        4160 Tyler St NE   Columbia Heights MN.   55421
 

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