WEBSITE PAYMENT
ADDITIONAL INFO (OPTIONAL)
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*LAST NAME
 *FIRST NAME
 MIDDLE INITIAL
 PAYMENT METHOD:
PLEASE CHOOSE A   *
PAYMENT METHOD:
*ADDRESS
 *CITY
 *STATE/PROVINCE
WEBSITE PAYMENT?
*
*COUNTRY
 SPOUSE( IF APPLICABLE )
 *POSTAL CODE
 *  CALL OFFICE WITH         
     CREDIT CARD #?         
*PHONE NUMBER
   EMAIL ADDRESS
 * MAIL IN PAYMENT WITH  
        APPLICATION?           
(WEBMASTER)  DANNY VAN WINKLE
DISCLAIMER: C . (2003-2005) THE ANTIQUE TRUCK CLUB OF AMERICA. INFORMATION IS
SUBJECT TO CHANGE WITHOUT NOTICE. THE ANTIQUE TRUCK CLUB, INC AND LOGO ARE
TRADEMARKS OF THE ANTIQUE TRUCK CLUB OF AMERICA INC. ALL OTHER TRADEMARKS
ARE  THE PROPERTY OF THEIR RESPECTIVE HOLDERS. ALL RIGHTS RESERVED.
MEMBERSHIP APPLICATION FORM
DUES INFORMATION
IF YOU OWN ANY ANTIQUE COMMERCIAL VEHICLES, PLEASE LIST THEM HERE:
 
CHAPTER REPS
YOUR MEMBERSHIP WILL BE BASED ON A 12 MONTH PERIOD, BASED ON YOUR JOIN DATE AND
 RENEWABLE EACH YEAR ON YOUR JOIN DATE. A STATEMENT FOR YOUR ANNUAL MEMBERSHIP  
DUES WILL BE SENT TO THE SUPPLIED ADDRESS UPON RECEIPT OF THIS APPLICATION.

NOTE: MEMBERS LIVING  OUTSIDE THE US MUST PAY THEIR DUES IN THE FORM OF A POSTAL
MONEY ORDER PAYABLE IN US CURRENCY.
ACTIVE MEMBERS LIVING IN:
U S A.....................................................................................$36.00
CANADA...............................................................................$48.00
ALL OTHERS LIVING OUTSIDE THE US..........................$54.00
CORPORATE MEMBERS IN THE US...............................$54.00
**NOTE: CORPORATE MEMBERS RECIEVE TWO COPIES OF DOUBLE CLUTCH.
PAY FOR YOUR DUES NOW, IF YOU LIKE. ...ONLINE!!
WHETHER YOU ARE A NEW MEMBER OR A CURRENT MEMBER
WANTING TO RENEW. USE THE "BUY IT NOW" OPTION TO USE A
PAYPAL ACCOUNT OR A CREDIT CARD THRU THE PAYPAL SITE.
US:
IF YOU ARE A CURRENT MEMBER AND WANT TO RENEW ONLINE, USE "BUY IT NOW" BELOW.
YOUR INFORMATION:
(NOTE) * DENOTES A REQUIRED FIELD.
PRINTABLE APPLICATION FORM.
JUST PRINT OUT AND MAIL IN
FOR MORE INFO ON THE ATCA OR,
IF YOU HAVE COMMENTS, CONTACT RACHEL AT OUR OFFICE:
85 S. WALNUT STREET BOYERTOWN, PA. 19512
PHONE:610-367-2567 OR FAX:610-367-9712.
EMAIL: OFFICE@ANTIQUETRUCKCLUBOFAMERICA.ORG
CANADA:
INTERNATIONAL:
CORPORATE: