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DODGE BROTHERS CLUB
MEMBERSHIP APPLICATION
_____New application;_____Renewal or former member. Membership
no. if known_____________
DATE:_____________________________
I hereby apply for membership in the DODGE BROTHERS CLUB,
INC. Enclosed are my dues, $25 per year U.S.
and Canada, and $31 overseas for single membership. Payment
in U.S. funds only drawn on a U.S. bank,
international postal order, U.S. money order or bank
draft negotioable in the U.S.A.
FULL NAME:___________________________________________________________________
Also add the following family members or spouse at $2.00
each:
NAMES:______________________________________________________________________
I understand that $17.00 of my dues ($25.00 overseas)
is for subscription to the DODGE BROTHERS CLUB NEWS.
ADDRESS_______________________________________________PHONE_________________
CITY_______________________________________STATE__________ZIP_________________
COUNTRY____________________________OCCUPATION_____________________________
Email Address__________________________________
Skills, advice, or ways you can offer assistance___________________________________________
List all Dodge Brothers/Graham Brothers vehicles you own
1938 and earlier (ownership is not
necessary for membership). Include parts cars, partial
restorations, untitled cars. Use additional
pages if necessary. List as much information as you can
about your vehicles:
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Vehicle 1 |
Vehicle 2 |
Vehicle 3 |
Vehicle 4 |
| Year |
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| Model |
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| Body type & No. |
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| Serial Number |
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| Engine No. |
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| Current Conditiona |
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| Remarksb |
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| Date acquired |
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| Previous owner(s) |
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a NPW=National Prize Winner; R=Restored; RNG=Restoring;
O=Original; P=Parts car; PNP=Parts car not parting;
M=Modified. Also indicate XC=Excellent; G=Good; F=Fair;
X=Poor.
b Unusual facts such as custom body, wood
body sills, special symbols prior to engine no., period overdrive, OHV
conversion, RHD, California top, high-compression head,
etc.
List special related literature, parts, memorabilia owned________________________________________________________
_____________________________________________________________________________
LIST OTHER ANTIQUE-CAR CLUBS (and offices held) TO WHICH
YOU BELONG_________
_____________________________________________________________________________
I WAS REFERRED BY___________________________AMOUNT ENCLOSED____________
MAIL TO: DODGE BROTHERS CLUB, P O BOX 1648, CAMBRIDGE, OH 43725
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