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Membership Application for the Potomac Classic Thunderbird Club (CTCI Chapter #23)

New Member:  Regular dues are $25.00 per year due January 1, with a reduction to $12.50 for half year from July 1 through December 31, plus an initiation fee for new members members (or existing members delinquent for 12 or more months) of $15.00 per person ($30.00 per couple) which includes name tags. Membership will be open to all persons who are members of the CTCI, Inc. who are interested in the express purposes of this Chapter. (PCTC Bylaws). (We will hold your check for 30 days pending notification of your CTCI number if you are joining CTCI also.  CTCI applications are available at www.ctci.org.)  

Renewing Member:  Dues are $25.00 per year due January 1; dues must be received by January 31 or a late fee of $5 dollars will be assessed..

Fill out the form below, then press Submit, and mail a printed copy along with a check payable to PCTC to:            

Terry Carlson, 
Secretary/Treasurer
Potomac Classic Thunderbird
Club  
2 Seneca Forest Court
Germantown, MD 20876

By pressing Submit you also affirm that your vehicle(s) named below is/are insured in accordance with the laws of your state of registration.

Name
Month/Day of Birth
Co-Applicant
Month/Day of Birth
Street Address
City, State, ZIP      
   
Telephone
Cell Phone
E-Mail   You Will Receive Your Monthly Newsletter (T-Bird Chatter) Notification at this E-Mail Address!
   
  New Members: Show preference for name(s) on badge:
 
CTCI Number (if known)  If you aren't a CTCI member already then you must apply for membership
Cars Owned
  (Please include year and color)