Membership Application


	P.O. Box 4124 Butte, Montana 59701 406-782-2282 Membership Application

Name:_______________________________________________________________	Age:_______________

Address:_____________________________________________________________	Zip Code:___________

Home Phone:__________

Work Phone:__________

Email Address:____________________

Family Members	Relationship	Age
1._______________________________________________	________________________________________	____________

2._______________________________________________	________________________________________	____________

3._______________________________________________	________________________________________	____________

4._______________________________________________	________________________________________	____________

5._______________________________________________	________________________________________	____________

Vehicle: Make, Model _____________________________________________

Year ___________

Insurance Carrier: __________________________________

Type of Coverage:____________________________

CB Radio? ( )Yes ( )No

Other Equipment: _________________________________________________________ _________________________________________________________

I have received and read the current By Laws of Contenintal 4 Wheel Drive Assoc. I hereby take notice that Contenintal 4 Wheel Drive Assoc. retains ownership of decals issued to each member and upon resignation or expulsion from the club, the member must return said decal to an officer of the club within forty-eight (48) hours.

________________________________________________ Date of Application	________________________________________________ Signature of Applicant
________________________________________________ Date Voted On	________________________________________________ Signature of Sponsor
________________________________________________ Date Dues Paid	________________________________________________ Signature of Treasurer