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Long Island Motor Touring Club, Inc.
(Formerly LI Model T Club, Inc.)Founded April 25, 1957
Date _____________________
Name:__________________________________________________
Street Address:___________________________________________
City/State:___________________________________ ZIP:__________________________
Phone:______________________________________ Occupation:_____________________
Cars intended for use in club events limited to those made in manufacturer's model year 1942 and earlier.
Please list eligible cars owned:
1.___________________________________ 5.___________________________________
2.___________________________________ 6.___________________________________
3.___________________________________ 7.___________________________________
4.___________________________________ 8.___________________________________
Other cars of special interest:
__________________________________________________________________________
__________________________________________________________________________
Other Hobby Interests:_________________________________________________________
Introduced or Proposed by:_____________________________________________________
Date Voted to Membership:____________________________________________________
Membership dues submitted with application $_____________________________
I certify that I have read and accepted the By-Laws and constitution of the Long Island Motor Touring Club, Inc.
Signed:_______________________________________
Please print out this form and mail with a $20 membership fee to:
Please make check out to: "Long Island Motor Touring Club"
Louise Josephson
1 Briar Road
North Merrick, NY 11566