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 $25 single_______$35couple_______  USFunds

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