MONTANA CROSS COUNTRY T ASSOCIATION

1004 Sioux Road. Helena, MT 59602

Mike Robison, Pres. Tony Cerovski, Vice Pres. Janet Cerovski, Treasurer

Application For Membership - 2009

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

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

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

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

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

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

Occupation..................._________________________________________________

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. The fee for touring with this event is $25.00.

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