Below you will find an application which can be used to apply to our club. Along with the application, please send a check for $15 made out to Moal Pleasant Mountain Chapter. Please print it out, fill it out, then send to the following address:

Wayne Warner

11 Texas lane

Bridgton, ME

04009


  MOAL Pleasant Mountain Chapter

                   Club Membership Application

Applicant  _________________________________

Spouse  ___________________________________

Street  ___________________________________

City________________________ Zip __________

E-Mail ____________________________________

Tel # _____________________________________

Cell# _____________________________________

Occupation _______________________________

Antique Cars Owned (25 Years or older)

Year   Make           Body Style         Condition

____   ________    ___________    _____________

____   ________    ___________    _____________

____   ________    ___________    _____________

____   ________    ___________    _____________

Please give brief autobiography on reverse side.