The Lincoln Mark VII Club Membership Application

The Lincoln Mark VII Club Membership ApplicationPage 1 of 2(also available online at http://TheLincolnMarkVIIClub.org/join)Today’s Date: __________________________I. Member InformationHandle or nickname:First Name:Last Name:Street Address:City/Town:State/Province:ZIP/Postal Code:Country:Date Of Birth:Home Phone Number:Cell Phone Number:Work Phone Number:E-Mail address:Shirt size:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________S__ M__ L__ XL__ XXL__ XXXL__II. Vehicle InformationYear: 1984__ 1985__ 1986__ 1987__ 1988__1989__ 1990__ 1991__ 1992__Model: Base__ Bill Blass__ Gianni Versace__ GTC__LSC (Luxury Sport Coupe)__ LSC SE (LSC Special Edition)__ Other__Engine: Ford 5.0__ BMW 2.4 Turbo Diesel__ Other__Exterior Color or Code:Interior Color or Code:VIN:________________________________________________________________________________________________________________________________________________________________________________________________Mileage:________________________________________________________________SUBMIT THIS PAGE ONLYThe Lincoln Mark VII ClubMembership SecretaryP. O. Box 42678Philadelphia, PA 19101-2678© T H E L I N C O L N M A R K V I I C L U B B O X 4 2 6 7 8 P H I L A D E L P H I A P A 1 9 1 0 1 – 2 6 7 8+ 1 6 1 0 9 3 1 6 6 2 3H T T P : / / W W W . T H E L I N C O L N M A R K V I I C L U B . O R GRev: 20110809

The Lincoln Mark VII Club Membership ApplicationIII. MembershipMembers receive:Club Specific Online Forum AccountClub Exclusive E-mail AddressClub Exclusive Online Photo GalleryClub Exclusive Ink PenClub Exclusive Quarterly NewsletterClub Exclusive T-ShirtClub Exclusive Window DecalPage 2 of 2KEEP THIS PAGEFOR YOUR RECORDSAnnual Dues are $25.00US. The Initiation fee is $15.00US. The first year cost = $40.00US Accepted forms ofpayment include cash, credit/debit card (only available online at http://TheLincolnMarkVIIClub.org/join),Paypal (PayPal@TheLincolnMarkVIIClub.org), money orders, and personal checks. When paying bymoney order or check, make the drafts payable to The Lincoln Mark VII Club. Please allow up to fourweeks for processing. Direct all Membership questions and applications to:The Lincoln Mark VII ClubMembership SecretaryP. O. Box 42678Philadelphia, PA 19101-2678membership@TheLincolnMarkVIIClub.org610.931.6623Today’s date:Payment method:________________________________________________________________________________________________________________________________Payment reference number: ________________________________________________________________Payment amount:________________________________________________________________© T H E L I N C O L N M A R K V I I C L U B B O X 4 2 6 7 8 P H I L A D E L P H I A P A 1 9 1 0 1 – 2 6 7 8+ 1 6 1 0 9 3 1 6 6 2 3H T T P : / / W W W . T H E L I N C O L N M A R K V I I C L U B . O R GRev: 20110809