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 Membership Chairman
4500 Williams Dr. Ste 212 PMB 216
Georgetown, TX 78633