MONTANA CROSS COUNTRY T ASSOCIATION

1004 Sioux Road. Helena, MT 59602

Application For Membership

Date of Application.........._________________________________________________

Name........................._________________________________________________

Address......................_________________________________________________

City........................._________________________________________________

State........................_________________________________________________

Zip Code....................._________________________________________________

Occupation (optional)........_________________________________________________

Year and Body style of car..._________________________________________________

Model T Ford Club of America membership number..._____________________________

Model T Ford Club International membership number.........____________________

Phone number................._________________________________________________

E-mail address..............._________________________________________________

You will be put onto the mailing list to receive all letters concerning the club's activities when you become a member of this association.

Dues are $10.00 per year.

This fee covers membership costs only and does not include the $35.00 entrance fee for the Montana Cross Country Model "T" Endurance Run or for touring with this event.

Please send check or money order payable to the Montana Cross Country "T" Association to the above address.

This club is not responsible for accidents.___________________________________

Applicant’s signature