CT TRIUMPH REGISTER -

 

    2012 MEMBERSHIP FORM

 

 

Membership in the Connecticut Triumph Register (CTR) is open to anyone with an interest in Triumph cars - any year, any model, and any condition! Previous Triumph owners, current Triumph owners, even prospective Triumph owners are welcome to join our family-oriented club. The membership year runs from April 1st 2012 to March 31st 2013. Dues are $30 per year; discounted to $20 per year if you agree to email delivery of the monthly newsletter and annual directory. If you join after September 1st 2012 dues are pro-rated to $15 (discounted to $10 if you agree to email delivery) for remainder of membership year.

 

Name:

 

Spouse:

Mailing Address:

 

City:

State:

Zip:

Home/Primary Phone:

 

Alternate Phone:

Email Address:

 

 

Are you a member of the Vintage Triumph Register?

[  ] Yes         

[  ]  No   (CTR is a local chapter of VTR- for more information go to www.vtr.org)

 

How would you like the monthly newsletter and annual directory delivered to you? 

[  ] By email (dues are discounted to $20)

[  ] By postal mail (dues are $30)

 

May we publish your contact and car information in a club directory (publish date is July 2012)?

[  ] Yes          

[  ] No

 

Triumphs and/or other British cars you own:

 

Marque

Year

Model

Commission No./VIN (optional)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

               

 

 

 

       

 

                                                           Send form and payment to:

 

CT Triumph Register

                   Terry Telke

                  389 Platt Ave

           West Haven, CT 06516

                 203-691-7138

               ttelke@gmail.com