Important: Fields marked with "*" are required.


First Name / Last Name:  *   *
Significant Other (S/O) First Name / S/O Last Name:  
Company Name:
Address:
Address2:
City:
State / Zip (+4):  
Country:
Phone 1:
Phone 2:
Phone 3:
Email Address:  *
S/O Email Address:
Second Address (For summer mailings only):
Second Address 2:
Second City:
Second State / Second Zip (+4):  
CTCI Number (Member / S/O):  
Birthday (MM/DD/YYYY):
S/O Birthday (MM/DD/YYYY):
Anniversary Date (MM/DD/YYYY):

Classic T-Birds and Other Cars Owned

( Format: <Year and Model>,<Color>,<License Plate>; ):


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