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 $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$18.33March $16.67 April $15.00May $13.33June $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: $
44444