Join BTW

Print this page, fill out the application and mail to BTW.
Or call the office to join with a credit card at (510) 317-8220

Membership Application - North America
BROTHERS OF THE THIRD WHEEL, INC.
HC71 Box 183-5, Ava, MO 65608 - USA

Please Circle: New Renewal Single Couple Referred By: J.B. & Carol Baldwin
Name:________________________________Spouse:_________________________________
Address:_____________________________________________________________________
City:___________________________State:__________Zip:___________Country:___________
Phone:(____)______________________ E-Mail: ____________________________________
Age:___________Birth Date(s):_______________________ Type of Trike:_____________________

Membership Fees NORTH AMERICA ONLY! (USA & Canada): $20 Single or $28 for couple per year. (US Funds Only)
NOTE: Outside N. America contact BTW - Europe! Optional Memorial Fund $5 per person (See Triker Mag. for details of Memorial Fund).

Total Amount:$ ____________ Today's Date: ______________ Check or Money Order Enclosed

Charge Card Number:__________________________________Expiration Date:_____________

I am applying for membership in Brothers of the Third Wheel Inc.
In so doing I understand I am Pledging to support the principles, purpose and functions of the association and will do my best to uphold its good name.