MVB Membership Form

Membership Application form

Midwest Vintage Bronco club (2008)

Name: __________________________________Family Members: _________________________________

Street Address: _________________________________________ New Membership: ______Yes ______No

City, State, Zip Code: ____________________________________________Renewal: ______Yes ______No

Home Phone: _________________________E-Mail: _____________________________________________

Other Phone Info: ______________________Website: ____________________________________________

How did you learn about Midwest Vintage Bronco’s? ______________________________________________

How many Broncos do you own? _______ What year(s)?:__________________________________________

Please describe your Bronco (include info such as color, engine, transmission, suspension lift, mods etc.)
If you have pictures that you can send, we can scan them in and will return them:

______________________________________________________________________

Any other Club affiliations:

______________________________________________________________________

Are you a member of the Minnesota 4 Wheel Drive Association (MN4WDA)? ______Yes ______No

If you would like to join the MN4WDA, send an additional $23 with your dues, the MVB will take care of obtaining your membership to the MN4WDA. (Membership in the MN4WDA makes you a member of the United Four Wheel Drive Association)

I am including an additional $23 for membership in the MN4WDA. ______Yes ______No

Are you a member of the Midwest 4 Wheel Drive Association (MW4WDA)? ______Yes ______No

Would like a Club representative to contact you. ______ Yes ______ No

Please return this form and include a payment of $30 for the MVB club membership, $53 for a dual membership in the MVB and the MN4WDA. Make checks payable to MVB, and mail to:

Midwest Vintage Bronco club
c/o Kurt Loftfield
890 Marnie Cir. S.
Maplewood, MN 55119