| 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: |
| Lone Star Model A Ford Club dues are $20 per calendar year and are due in December for the following year. Dues are prorated based upon when you join the club. Please use the following schedule for the amount of dues to pay: |
| January | $20.00 | February | $18.33 | March | $16.67 | April | $15.00 | May | $13.33 | June | $11.67 | |||||
| July | $10.00 | August | $ 8.33 | September | $ 6.67 | October | $ 5.00 | November | $ 3.33 | December | $ 1.67 |
| Dues | $ | 20.00 for a full year | |
| Additional Rosters at $2.50 each: | $ | ||
| Mailing Roster: | $ | 3.00 Make check payable to "LSMAFC" | |
| Total Amount Enclosed: | $ | ||
| We recommend that if you join the club in August or later that you include the following year's dues ($20) to your first year's dues. Otherwise, another dues payment will become due in December for the following year. If you want your roster mailed to you, please add $3.00 for postage. Your dues include one free club roster; additional rosters are $2.50 each. |
| After filling out the form, print it and bring your check to a monthly meeting or to the Saturday morning breakfast at Georgetown IHOP. Or, you may mail it with a check to: |
LSMAFC Membership Chairman 4500 Williams Dr. Ste 212 PMB 216 Georgetown, TX 78633 |