| Your Name: | ||
| Spouse's Name: | ||
| Address: | ||
| City: | State: | Zip: |
| Home Phone: | ||
| Your Occupation: | ||
| Your Work Phone: | ||
| Your Cell Phone: | ||
| Your Email Address: | ||
| Your C.B. Handle: | ||
| Your Birthday (Month and Day only): | ||
| Spouse's Occupation: | ||
| Spouse's Work Phone: | ||
| Spouse's Cell Phone: | ||
| Spouse's Email Address: | ||
| Spouse's C.B. Handle: | ||
| Spouse's Birthday (Month and Day only): | ||
Minor Children living at home (name & age):
| Name | Age |
Model A's owned:
| Year | Body Style | Restored/Unrestored | Car's Nickname |
Please change/correct the following information as listed in last year's club roster:
Please complete the above information and give to Fred Carlton along with a check payable to “Lone Star Model A Ford Club” or mail to:
Lone Star Model A Ford Club Membership Chairman PO BOX 1049 GEORGETOWN TX 778627-1049
If you wish to have your roster mailed to you, please include an additional $2.50 for the postage and envelope. Each member receives a single copy of the club roster free with their dues renewal; additional copies of the club roster are $2.00 each. The new roster should be available by the February meeting if you wish to pick up your copy in person.
| Dues | $ | 20.00 |
| Additional Rosters at $2.00 each: | $ | __________ |
| Mailing Roster: | $ | 2.50 |
| Total Amount Enclosed: | $ | __________ |
Lone Star Model A Ford Club dues are $20 per calendar year and are due in December for the following year. Dues should be paid by December 31st for you to be included in the new year's roster. 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 | May | $13.33 |
September |
$6.67 |
| February | $18.33 | June | $11.67 | October | $5.00 |
| March | $16.67 | July | $10.00 | November | $3.33 |
| April | $15.00 | August | $ 8.33 | December | $1.67 |
Our bylaws require that you also belong to the national club, the Model A Ford Club of America (MAFCA). The dues to belong to MAFCA are $30 per year and include a subscription to The Restorer magazine (6 issues per year). If you are not already a member of MAFCA, please mail your $30 to:
MAFCA 250 SOUTH CYPRESS ST LA HABRA CA 90631-4486
Last updated on January 07, 2008