| MEMBERSHIP APPLICATION FORM Copy and paste the form below into your word processing program, print, fill-out and mail to the address at the top of the form or email the form to [email protected] For information on dues and more, contact Mr. Bill Little or another member listed at the bottom of the form. |
| NORTH LOUISIANA VINTAGE TRACTOR CLUB
IMPLEMENTS AND HEAVY TRUCKS P O BOX 154 QUITMAN LA 71268 MAIL APPLICATION AND $30.00* MEMBERSHIP DUES TO THE ABOVE ADDRESS � ATTN: LARRY HUDLESTON MEMBERSHIP FORM Date: _____________________ Name: ____________________________________________________________________ Address: __________________________________________________________________ City: ______________________________LA Zip Code: ______________________ Phone Number: Area Code _______- _______- _____________ Cell Phone: ________- _______ - ________ EMAIL: ______________________________ Type of equipment owned: Antique Tractor 1970 or Older _________ Make Model & Year ______________________________________________ Antique Farm Implement ________ Item Make Model & Year ___________________________________________ Antique Farm Truck ______________ Make Model and Year _______________________________________________ * $20.00 is for a family membership, including spouse and children under age 21. $10 is for EDGE insurance for the person listed above. For any additional person that will be participating in events an additional $10.00 for the insurance should be remitted with along with their name. For further information, contact a person listed below or any club member. Bill Campbell Bill Little Barry Howard 318-627-3552(H) 318-343-6115(H) 318-352-3147(H) 318-452-2664(C) 318-381-6115(C) 318-663-5335(C) Tommy Addison Dan Little Skeet Cooper 318-377-3639(H) 318-323-5811(H) 318-992-2206(H) 318-218-3675(C) 318-366-5811(C) 318-419-2294(C) Larry Huddleston 318-259-4316 |