MEMBERSHIP FORM HEARTLAND T's of OKC Affiliated with The Model T Ford Club of America Print & complete this form and send it & $20.00 to:     Mike Mayfield P.O. Box 598 Piedmont, OK 73078   If you are not a member of The Model T Ford Club of America please add $ 40.00 for National dues.   Please print or type information Name___________________________________ Mailing address______________________ E-Mail__________________________ City____________________State_____Zip__________ Home Phone____________Work________________ Name of spouse____________________________ National Membership Number__________________ Occupation______________Bus Name____________ Model T's Owned Year-----------Style------------Condition __________________________________________ __________________________________________ __________________________________________