Joining the Registry for the
purpose of simply documenting your Chalmers automobile and
owner data remains no fee. Please let me know if you desire to be in this
category and not
received the newsletter. See fees at the bottom of the page. No personal
information will be
share with anyone without your permission.
Registration Form
(Please fill as information as possible)
Year___________Model________________________________________________
Serial Number________________________ Engine Number_____________________
Body number________________(Stamped into Seat Frame) Mileage______________
Condition (circle one)
(1) Excellent (2) Very Good (3) Good (4) Restorable (5) Parts
Color Body_________________Fender________________Hood__________________
Features_______________________________________________________________
______________________________________________________________________
Missing items and Alterations________________________________________________
Current Use (Show-Drive-Tour-Restoring)_____________________________________
Previous Ownership History_________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Name_________________________________________________________________
Address_______________________________________________________________
______________________________________________________________________
Email Address___________________________________________________________
Can we email the newsletter? Yes No
Phone # Home ___________________________Cell____________________________
This information is intended for use by the Chalmers Automobile Registry and its
members. It is strictly forbidding for any other use.
Can phone number be listed on membership list to be mailed to current members?
Yes No
Can email address be listed on membership list to be mail to current members?
Yes No
Can address be listed on membership list to be mail to current members?
Yes No
Photograph (optional) Yes No
More information use a separate of paper.
Sign me up for one year newsletter subscription
Enclose $5 US funds cash or check payable to JOE ALACKNESS
Memberships run January 1st-December31st
After September 30 dues will include next year.
Foreign membership $5 by email. Check with Registry for postal rate.
Signature___________________________________________Date________________
Email chalmersregistry@chalmersregistry.com
Snail mail Chalmers Automobile Registry
Joe Alackness
908 2nd Ave
Royersford, PA 19468 USA