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                                                      Wheels of Thunder                                            
                                              Membership Application

Sponsor Name  __________________________________________________________

Applicant's Name   ________________________________________________________

Name of Spouse  _________________________________________________________

Address  _______________________________________________________________

City  _____________________________  State  ________  Zipcode  _______________

Telephone No.  ____________________   Cell Phone No.  ________________________

E-Mail Address  _________________________________________________________

Date o fBirth  ___________________________________

Automobile Info:

Make:  _____________________________________________________

Model  _____________________________________________________

Year  ______________________________________________________

Emergency Contact Information:

Name:  ______________________________________________

Relationship  __________________________________________

Telephone No. ________________________________________

Signature  ____________________________________________   Date  ________________

Please return application with $25.00 annual Membership Fee to:

Wheels of Thunder

PO Box 653

Bridgeton, NJ 08302