Name _____________________________________________________
Spouse ____________________________________________________
Street Address ______________________________________________
City/State/Zip _______________________________________________
Home Phone _________________ Work Phone (Optional) ___________
Email address _______________________________________________
T-Bird Data:
Years(s) _____________________ Color(s) ______________________
License Number(s) __________________________________________
Serial/Data Plate Number(s) ___________________________________
Driver's License # _________________ CTCI # _________________
Insurance Company _________________________________________
For our newsletter to celebrate your special occasions:
Birthday (Month/Day) _________________________________________
Spouse's birthday (Month/Day) __________________________________
Wedding anniversary (Month/Day) _______________________________
Sponsored by (Website or member's name) _______________________
Amount Submitted _____________ Check Number ________________
Please write a few comments about yourself (hobbies, interests, specialties on the back of this application
form).
Mail this completed form with your check, payable to Early Birds of Southern California, to:
Early Birds of Southern California, Attn: Vice President/Membership Chairman, 4603 Calle
De Grande, La Verne, CA 91750
Depending on when you join, your check amount should be one of the following to cover the $8 one-time initiation
fee and prorated dues:
$33.00 January-March $27.00 April-June $20.50 July-September
$14.50 October-December
NOTE:
Concurrent membership in our parent organization, CTCI, is mandatory for membership and acceptance.
To obtain CTCI information, visit their website at http://www.ctci.org or inquire at: Classic Thunderbird Club International, 1308 E. 29th Street, Signal Hill, CA 90755 Phone
(562) 426-2709.
