Wheels of Thunder                                             
Membership Application

 

 

Sponsor Name  __________________________________________________________

 

Applicant's Name   ________________________________________________________

 

Name of Spouse  _________________________________________________________

 

Address  _______________________________________________________________

 

City  _____________________________  State  ________  Zipcode  _______________

 

Telephone No.  ____________________   Cell Phone No.  ________________________

 

E-Mail Address  _________________________________________________________

 

Date of Birth  ___________________________________

 

Automobile Info:

Make:  _____________________________________________________

 

Model  _____________________________________________________

 

Year  ______________________________________________________

 

Emergency Contact Information:

Name:  ______________________________________________

 

Relationship  __________________________________________

 

Telephone No. ________________________________________

 

Signature  ____________________________________________   Date  ________________

 

Please return application with $25.00 annual Membership Fee to:

Wheels of Thunder

PO Box 653

Bridgeton, NJ 08302