Membership Application

San Fernando Valley Model A Ford Club
Membership Application / Renewal Form

Members: Last Name First Name DOB Month & Day

1) __________________________________ ____________________ _____ / ____
Cell: ( ) ______________ Email: ________________________________________________

2) __________________________________ ____________________ _____ / ____
Cell : ( ) ______________ Email: _______________________________________________

Children: ( under age 18 – Cost $1.00 per name)
1) __________________________________ ____________________ _____ / ____
2) __________________________________ ____________________ _____ / ____
3) __________________________________ ____________________ _____ / ____
4) __________________________________ ____________________ _____ / ____

Home Address: ________________________________________________________________
City: ______________________________________ State: ______ Zipcode: ____________
Home Phone: ( ) ________________________
Wedding Anniversary Date, if applicable: ___ /___ / ________ (Month / day / year)
List all Model A cars owned by Year and Body Style.
______ _____________________________ _______ _____________________________
______ _____________________________ _______ _____________________________
______ _____________________________ _______ _____________________________

A Family membership will receive one (1) copy of the Club’s monthly newsletter ‘The Rumble Sheet’, which will be sent via Email to the first email address listed above unless otherwise specified by placing an X in the appropriate box below.
I / We do not own a computer and/or use email. Send newsletter by Snail Mail to my Home Address.
Please send newsletter to the second email address listed above, and not the first.

Membership in a National Model A Organization is required to become a member of the SFVMAFCA. Please provide your membership number(s) and circle the applicable National Model A organization(s).
MAFCA / MARC Membership No. _______________________.
I have applied for membership in MAFCA / MARC (circle whichever applies) and understand my membership to SFVMFA is not effective until my MAFCA/MARC membership number is provided.

Return this application along with payment to the Membership Chairperson
Or mail to : SFVMAFC – Membership, P.O. Box. 8017, Van Nuys, CA 91409
Checks are payable to San Fernando Valley Model A Club or SFVMAFCA.
The total amount due is the sum of the following three (3) items:
1) Annual dues $26.00 2) $1.00 for each child 3) $5.00 for A.C.C.C. donation.

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