CPTC Membership Application
To join, complete this form and send it along with a check for $20.00 annual dues to:

			Central Pennsylvania Triumph Club
			PO Box 493
			New Kingstown, PA 17072-0493

Name: _____________________________________

Spouse's Name: ____________________________

Address: __________________________________

City: _____________________________________ 

State: _____________ Zip: _________________

Phone:(______)_________-___________________

E-mail: ___________________________________

New Member:
Renewal:

Indicate the car(s) you have by:

MODEL
YEAR
COLOR
MILES/YEAR
COMMISSION #


Are you a member of the Vintage Triumph Register? _________

What would you like the club to provide for you and your Triumph? _________________________________________________________________
_________________________________________________________________
_________________________________________________________________