APPLICATION TO Join THE
                  ARKANSAS TIN LIZZIES CLUB

Name_____________________________ Birth date ____________

Spouse name ______________________  Birth date ____________

Address ___________________________________  

City        _______________________________  Zip ____________

Type of Model T _________________________________________

Model T club affiliations____________________________________

Telephone # _______________ e-mail _______________________

Cell phone # _______________

Other suggestions, or comments_____________________________

______________________________________________________

______________________________________________________

Our club meets in one of four different zones in Arkansas
four times a year.

Annual membership dues per family: $10.00

Please return this form with your check payable to
“Arkansas Tin Lizzies” to the following address:

    David Ragsdale
    216 N. El Paso, Suite A
    Russellville, AR 72801

Of If you have any questions you may contact Nellie Howell at (479) 229-3878