Back

View a PFD version of the application:

 

TRI-STATE ANTIQUE TRACTOR CLUB INC. &
 EDGE&TA Branch 174
MEMBER APPLICATION
New member: __________ Renewal: ____________
DATE: _________________
2014 Membership dues is $25.00 for 2014.  Tri-State Antique Tractor Club year is Jan.1-Dec.31. Tri-State Antique Tractor Club Membership also includes a membership with Early Day Gas Engine & Tractor Assn. Inc. (we are EDGE&TA Branch 174) the benefit card you will get covers you for liability insurance for your hit miss engine or tractor.  EDGE&TA yr. is April 15 to April 15.  You will receive two membership cards. A Tri-State Antique Tractor Club Card and a yellow plastic EDGE&TA card. KEEP the yellow EDGE&TA card because when you renew your membership you will be issued a new (Year) sticker for the yellow card.

Tell us about you:
NAME: _______________________________________________________________________
STREET: _____________________________________________________________________
CITY: _____________________ STATE. __________ ZIP: ____________
HOME PHONE: ________________________CELL: ________________
Date of birth ___/____/____ yr. optional
e-mail: ________________________________________________________________________
SPOUSE INFO:
NAME: _______________________________________________________________________
Date of birth ____/____/____ yr. optional
e-mail: ________________________________________________________________________


Does your spouse drive a tractor OR sit with the engine at events?  YES/NO
IF YES they need to become a member of the club to be covered under the insurance.  The cost will be $15.00 for the yr.  They will also get an  EDGE&TA card.
You do not have to own a tractor or an engine to be a member! Do you have an engine or a tractor? If YES.....What do you have?( ALL makes/models built prior to 1984)________________________________________________________________________________________________________________________________________________________

Do you want your Name, Address, Phone No., & Tractors on the membership list mailed to other members? YES/NO Would you like to purchase a Club t-shirt? YES/NO   What size _______
Interests: Are you a member of any other clubs?
If so what are they: ______________________________________________________________                                                                                                
Sometimes our club members profession can be of service to the club and its members, please let us know what you do.____________________________________________________________ ______________________________________________________________________________
Any hobby that is a specialty? ______________________________________________________

In case of an emergency who should we contact:
Name: __________________________Phone: _________________
Relationship: ____________________________

Please make checks payable to :Tri-State Antique Tractor Club Inc.
and mail to : 397 Stonebridge Rd, Schuylerville, NY 12871
Phone: 518-695-4325 if you have any questions.

Event Schedule can also be found at  www.edgeta.com we are listed under NY Branch 174

Back