MIAMI VALLEY TRIUMPHS                MEMBERSHIP APPLICATION
Please complete, print and mail completed application with $25.00 (1st Year, Subsequent yearly dues are $20.00)payable to:

MIAMI VALLEY TRIUMPHS
P. O. Box 144
Bellbrook, Ohio 45305

NAME   BIRTH DATE     TODAY'S DATE
ADDRESS   PHONE  
CITY   STATE   ZIP CODE 

Car # 1                                                     TRIUMPH VEHICLE PROFILE

YEAR    MODEL   COMM #   BODY COLOR    INTERIOR COLOR   
TOP COLOR 
DISTINGUISHING FEATURES 

Car # 2
YEAR    MODEL   COMM #   BODY COLOR    INTERIOR COLOR 
TOP COLOR 
DISTINGUISHING FEATURES 

MIAMI VALLEY TRIUMPHS            PERSONAL PROFILE

I am Interested in:   Cntrl+Click to hi-lite multiple selections.
Other:

Spouse Name   Children

I have the following experience/EXPERTISE that I am willing to share with my MVT cohorts: 

I have the following QUESTIONS that I would like to get some help in finding answers:

Occupation   Employer   
Work Phone Ext   Home Phone
e-mail

Form MVT4.1, 04/19/07/Web           MVT HOME PAGE