| Member Information:
Name:_______________________________________________________________ Address:________________________ City:___________________________ Phone#:_______________________________
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| Tractor Information:
Year:______________ Make:_______________________ Model:_______________ Year:______________ Make:_______________________ Model:_______________ Year:______________ Make:_______________________ Model:_______________ Year:______________ Make:_______________________ Model:_______________ |
Please enclose $20 check for membership made payable to NATPA of NE!
Return this form to:
Michelle Biel
2571 18th Road
Central City Ne 68826