I hereby apply for membership in the DODGE BROTHERS CLUB, INC. Enclosed
are my dues, $40 per year U.S., $45 Canada and Mexico, and $50 overseas for ...
DODGE BROTHERS CLUB MEMBERSHIP APPLICATION _____ New Application _____ Renewal or former member Membershipt No., if known: ___________________________________________ DATE: _______________________ I hereby apply for membership in the DODGE BROTHERS CLUB, INC. Enclosed are my dues, $40 per year U.S., $45 Canada and Mexico, and $50 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 negotiable in the U.S.A. FULL NAME: ___________________________________________________________________ Also add the following family members or spouse: (must reside at same address as primary member) 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: Vehicle 1
Vehicle 2
Vehicle 3
Vehicle 4
Year Model Body Type & No. Serial Number Engine No. Current Conditiona Remarksb Date Acquired Previous Owner(s)
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; P=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 PO BOX 1648 CAMBRIDGE, OH 43725
