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
 
 ______ CLUB  JACKETS  ______SECRETARY ______GIFT COORDINATOR

 _____GUEST SPEAKER  _____MEETING LOCATIONS _____ WEBSITE COORDINATOR

(OTHER POSITIONS ARE NOMINATED POSITIONS)

YEAR AND MODEL OF THUNDERBIRD(S) OWNED:

Year:________  Model_____________________________

Year:________  Model_____________________________

Year:________  Model_____________________________

OTHER SPECIAL INTEREST CARS: ___________________________________

The annual dues are $25 and a full year runs from April 1^st to April 1^st. 
Send application and check to:

 Cliff Lieske
 4160 Tyler St. NE
 Columbia Heights, Mn.   55421