Capital Triumph Register
Membership Application
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
SonDaughterOther / SonDaughterOther
SonDaughterOther / SonDaughterOther
My Triumphs – Please use the back for additional cars
My Interests -- Check all that apply. Feel free to volunteer for anything and everything!
Britain on the Green / Social Events
Road Tours / Web Site
Tech Sessions / Club Governance
Newsletter / Other:
Newsletter Preference and Fees
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.