The 30th T/A Organization Form

The 30th T/A Organization Membership Form

Mail to:
Robert M. Willis
841 Nueway Drive
Lebanon, Ohio, 45036-8085

__  30th T/A Organization Member $20.00 / year  (NON-PROFIT)
**Money Goes to Pay For the URL (www.30th-ta.org), Forum/Messageboard Software, Static Stickers, and Business Cards**

Please Make Check Payable to Robert Willis and feel free to include any information about your car, stories, modifications, or some pictures for the webpage

The Membership Includes:
  1. Official Member Number
  2. Some Official 30th T/A Organization Business Cards (~15)
  3. One Official 30th T/A Organization Static Window Sticker
  4. Webpage (if wanted - please contact me)

Last Name___________________________________ First Name_______________________

Street Address_________________________________________________ Apt. #_________

City________________________________ State____________________ Zip_____________

Home phone _________________ Work Phone_________________________

Email Addresses _____________________________________________

30th T/A Information: (please check or fill in all that apply)

Year _______ Model ________ Coupe _______ Convertible _______

Vin# __________________________________________ Car# ___________

Transmission ______ Hurst Shifter (if M6) __________ Traction Control ____________

Moonsoon CD _________________ 12 Disc CD ________ Tape Player _________

 

Do Not Write Below This Line
---------------------------------------------------------------------------------------------------------------------------------------

Business Card______ Window Sticker______ Membership Date___________