Mustang Club of Central Iowa - Membership Application

MUSTANG CLUB OF CENTRAL IOWA - MEMBERSHIP APPLICATION

Print out a paper copy of this page (you can fill it out on the screen) and mail with appropriate first year dues to:

Mustang Club of Central Iowa
Attn: Membership
PO Box 8383
Des Moines, IA 50301

Dues are $20.00 per year.

All dues renew annually based on the month you join.

Children 18 years of age and older are required to join as separate members.

Type info into blanks, then print out form.

Date   


Have you ever been a member of this club in the past?   Yes   No   

                                      If "Yes", when?  


Name:	

Address:

City:	  State: 

ZIP:	               Phone: 

Country:

E-mail address: 



Are you a member of Mustang Club of America (MCA)?   Yes   No   

      If "Yes", what is your MCA membership number?  


Are you a member of Shelby American Automobile Club (SAAC)?   Yes   No


Membership is for:   Self   Family  


If family, list names & birthdates:





Type and description of collectible Fords you own:




List any special talents or assets you have available that may be of 

    special benefit to the club (computer, special business or 

    restoration skills)





Interests: (choose any that apply)

Car Showing   Autocross   Open Track   Drag Racing   

Cruising   Restoration   General Interest 



64 1/2-66   67-68   69-70   71-73   74-78   

79-83   84-93   94-98   99- 


Amount enclosed   (dues are $20.00 per year)