Golden Wheels Membership Form
Name _______________________________________________________________
Spouse's or significant other name____________________________________
Address______________________________________________________________
City___________________________State______________Zip Code___________
Phone#________________________Birthday_______________________________
E-mail Address_______________________________________________________
Web Site______________________________________________________________
Do you own a vintage car: Currently (Y/N)?_______Previously (Y/N)?______
Brief car profile________________________________________________________
_______________________________________________________________________
Brief personal profile___________________________________________________
_______________________________________________________________________
Returning member(Y/N)?____________________________________
Sponsored by_______________________________________________
Annual dues are $30 single_________$40 couple_________ US$
Amount enclosed_____________Date__________________________
Check or money order made out to "Golden Wheels Fraternity"
Please mail application and payment to:
Golden Wheels Fraternity - P.O.Box 33487 - Seattle, WA 98133