Lone Star Model A Ford Club Membership Form

First name:		Spouse;	First name:
Last name:			Last name:
Occupation:			Occupation:
	(If retired, please so state and indicate former profession)
Work Phone:			Work Phone:
Cell Phone:			Cell Phone:
Email:			Email:
Radio Handle:			Radio Handle:
Birth Month and Day:			Birth Month and Day:
Home Phone:

Address:

City:

State:

Zip:

Model A’s
Year:     Body Style:     Restored Unrestored    Nickname
Year:     Body Style:     Restored Unrestored    Nickname
Year:     Body Style:     Restored Unrestored    Nickname

Lone Star Model A Ford Club dues are $25 per calendar year and are due in December for the following year.

Dues	$	25.00 for a full year. New members who join in October, November, or December of any year will pay $25, and that amount will include their dues for the following year.
Additional Rosters at $3.00 each:	$
Mailing Roster:	$	2.50                                          Make check payable to   “LSMAFC”
Total Amount Enclosed:	$

After filling out the form, print it and bring your check to a monthly meeting or to the Saturday morning breakfast. Or, you may mail it with a check to:

LSMAFC  Sondra Carlton 4500 Williams Dr. Ste 212 PMB 216 Georgetown, TX 78633