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ADIRONDACK TRIUMPH ASSOCIATIONPO Box 225
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Please print this application, print or type all information, and mail to the address above with your check.
Name: __________________________________________________________________
Family Members: __________________________________________________________
________________________________________________________________________
Address: _________________________________________________________________
City: _____________________ State: _____ Zip: _________
Home Phone: ( ) ________________
Occupation: ________________________________________
Work Phone: ( ) _________________
E-Mail Address (if you are online): _____________________________________________
Circle one:
New Application; if so, how did you hear about ATA? _______________________________
Renewal; ATA Membership # ________
VTR Member? __Yes __No Member #______
Please list all British automobiles that you currently own:
Year / Make / Model
________ _________________ _________________
________ _________________ _________________
________ _________________ _________________
________ _________________ _________________
________ _________________ _________________
Please list any other car clubs of which you are a member:
______________________________________________________________________
Dues: $20.00 per year, payable November 1. New members joining after May 1 pay $10.00. Make checks payable to Adirondack
Triumph Association or ATA. A portion of the annual dues goes toward a subscription to British
Marque Car Club News.
| ATA use only: Received by: __________ Entered in Database____ Notified Member____ Member Number______ |
Amount enclosed $__________________Date: _____/_____/_____
Applicant's Signature _____________________________________
Revised 3/1/08 * Questions, comments, suggestions? E-mail the Webmaster