Niagara Frontier Region

MODEL 'A' RESTORERS CLUB

APPLICATION & ROSTER INPUT FORM

(Please Fill out Completely & Print)

Model 'A's Owned

Use separate sheet for more 'A's and collectible cars owned

 

Mail this Form & A Check For The Membership Fee of $20 per person to:

 

James Coughlin, Jr. Membership Chair, 137 Cushing Pl, Buffalo, NY 14220

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MODEL 'A' RESTORER'S CLUB

6721 Merriman Avenue, Garden City, MI 48135

Dues for one calendar year are $45.00 U.S. residents
and $52.00 (U.S. funds) for Canadian residents.

APPLICATION FOR NATIONAL MEMBERSHIP

Includes subscription to the Model 'A' News Magazine

Applicant's Signature_______________________

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Model A Ford Restorer's Club
Niagara Frontier Region