Application for Trans Am Club of America, Dayton Ohio Membership-
(Print and fill out)Name: __________________________________________ Email:________________________________
Address:____________________________________________
City:______________________________________
State/Province: _________________________ Zip:____________
Country:_______________ Phone:( )________________
Spouses Name:_____________________
Signature: ____________________________________
Date:______________
Model of Car: _____________ Year: ______
Exterior/Interior Color:_________________
Body Style:__________________
Other Special Features: ____________________________________________________________
____________________________________________________________
Your Birthday: ____________ Spouse Birthday:____________________
Anniversary:_____________________
Children’s Names and Birthdays:
_______________________________________________________________________________
_______________________________________________________________________________
Membership Fees: $24.00 per year.
Make your Check payable (U.S. Funds) to TACA-Dayton Ohio Chapter, Inc.
Send Dues to:
Susan Emmel 5853 Stonegate Ct. Huber Heights, Ohio 45424-1131