Please print this form, fill it out and mail along with check to:
GWTA, 6010 Cadillac Drive, Indianapolis, IN 46224.
Phone: 317-244-3253 or e-mail us at: [email protected]

 

  1. Name: ________________________________
  2. Mailing Address: _________________________
  3. State/Province: __________________________
  4. Zip: __________________________________
  5. Home Phone Number: ____________________
  6. Work Phone Number: ____________________
  7. E-Mail Address: ________________________
  8. Enclosed is $ __________ for __________ year(s)
  9. _____Individual or _____Family for membership
    in the Gold Wing Touring Association.
  10. Please charge my _____Visa _____MasterCard
  11. Card # ___________________________________
  12. Expiration Date: _____Month _____Year

Recruiting to B. Ward, Member #8883

Any questions, e-mail me at: [email protected]


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