Twin-Power Heritage Association Inc.

                                                    Application For Membership Form

Full Name: (please print)                                                                                                                 

Name of Spouse:                                                                                                                             

Address:                                                                            City:                                                     

Province/State:                                                    Postal Code:                                                      

Telephone Number: Area Code (             )                            email address:                                

Please List Massey Tractors and Equipment Owned:                                                                    

_____________________________________________________________________

_____________________________________________________________________

I am also interested in: (please circle)     Toys          Literature                                                       

Other:________________________________________________________________

If you are a current or former Massey dealer or employee, please describe the position held:

_____________________________________________________________________

Will you allow us to publish your address and phone number in the club membership list?

 (Circle one)       Yes            No  

Signature:                                                                           Date:                                                            

Please mail this completed form and cheque for $30.00 (made payable to Twin-Power Heritage Association Inc.) to:

Colin Petherick, RR#5, 463 County Rd 8, Campbellford, ON, Canada  K0L 1L0

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