Name Spouse/Partner
Address 1
Address 2
City         
State - Prov State - Province Connecticut New Jersey New York ----------------- Alabama Alaska Alberta American Samoa Arizona Arkansas Armed Forces AA Armed Forces AE Armed Forces AP British Columbia California Colorado Delaware District of Columbia Fed. States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Mexico Newfoundland & Labrador North Carolina North Dakota N. Mariana Islands Northwest Territories Nova Scotia Nunavut Ohio Oklahoma Ontario Oregon Palau Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon Territory Zip / Post Code
Evening Phone      Day Phone
preferred email    
alternate email      

I _____________________________________(signature please) hereby apply for membership in the NYConn Chapter of the New England MG T-Register, Ltd. and am mailing my membership fee of $20.00 to the address above.

Tell us about your MG(s)
(The Car and engine number should be complete with letters as well as numbers. These can be found on the 3" x 4" Maker's Plate affixed to the battery box, tool box or firewall of your car. TD owners should include the letters in the lower half of the Car No. Rectangle: i.e. EXL, EXLU, EXL/NA, etc.)

Car #1 Model Year Body Style
Car # Engine #
Special Notes, Features or Modifications

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Car #2 Model Year Body Style
Car # Engine #
Special Notes, Features or Modifications

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Car #3 Model Year Body Style
Car # Engine #
Special Notes, Features or Modifications

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How did you learn about NYConn
Are you a New England MG T-Register Member? Membership No.
Are you reactivating a Membership that was interrupted? With the same car?
Has any car on this form been registered with a prior owner? Which one(s)
If yes, which NEMGTR Numbers? Do you have that person's permission to retain that register No.?