CTR Membership Application

Capital Triumph Register
Membership Application

Date: / CTR Membership No. (CTR Use Only):
First Name : / Last Name:
Sig. Other First Name: / Sig. Other Last Name:
Address:
City: / State: / Zip:
Home Phone: / E-Mail:
Work Phone: / Cell Phone:
VTR Member (check)? / VTR Membership No. (if member):

About my Family -- Please register my family members (under age 18, please) as CTR Associate Members

First Name / Last Name / Relationship / First Name / Last Name / Relationship
SonDaughterOther / SonDaughterOther
SonDaughterOther / SonDaughterOther

My Triumphs – Please use the back for additional cars

Model / Year / Commission No. / Color / Unique Features

My Interests -- Check all that apply. Feel free to volunteer for anything and everything!

Activity / I’ll Help / I’ll Plan / Activity / I’ll Help / I’ll Plan
Britain on the Green / Social Events
Road Tours / Web Site
Tech Sessions / Club Governance
Newsletter / Other:

Newsletter Preference and Fees

The Standard. CTR distributes its newsletter electronically via e-mail link to our web site. This provides our members with a real-time, printable, color publication. If you would prefer to receive a black and white hard copy note the additional fees which cover the cost of printing and postage.
Select one: / One Year Membership (emailed newsletter) / @ / $25.00 / $ / 0.00
Two Year Membership (emailed newsletter) / @ / $40.00 / $ / 0.00
One Year Membership (mailed hard copy) / @ / $30.00 / $ / 0.00
Two Year Membership (mailed hard copy) / @ / $50.00 / $ / 0.00
Extra CTR Window Decals (one is free) / @ / $1.00 / $ / 0.00
TOTAL ENCLOSED / $ / 0.00

Capital Triumph Register
Membership Application

With my signature, I, and my heirs, release Capital Triumph Register from any liability for damages or injury to me, my guests, or my property and materials while traveling to or from or while attending any club-sponsored event.

Signature

Send this form and your payment to:
Art Fournier, CTR

4729 Willows Rd.

Chesapeake Beach, MD 20732

Capital Triumph Register
Membership Application

Questions? E-mail to or call Art Fournier at 410-535-0690.