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