Application/Renewal – Trans Am Club of America, Dayton Chapter, Inc.

Applicant Name *

Spouse Name

Address *

City *

State/Province *

Zip *

Country

Phone

Email *

Applicant Birthday (Month/Day)

Spouse Birthday (Month/Day)

Anniversary (Month/Day)

Children Names

Children Birthdays

Car year

Make of Car

Model of Car

Exterior Color

Interior Color

Engine

Transmission

Roof type

Other Special Features

Club Dues (with processing fee)

Price: $0.00

Payment (click dropdown for PayPal or Credit Card) *

Card Number

Expiration Date

Security Code

Card Holder Name

Membership (includes spouse if applicable (includes voting privileges, access to Club functions, one year subscription to Club newsletter.

If you perfer writing a check, Make your $24 check payable (US funds) to Trans Am Club of America, Dayton Chapter, Inc.

For further information on membership contact:

Trans Am Club of America, Dayton Chapter, Inc. c/o Cheryl Minor 8909 Tripoli Drive Cincinnati, OH 45251 513-202-1212 Cheryl@TACADCinc.com

Any check dishonored by a bank and returned to TACADC will be subject to a charge of $15.00.