| Please print and
complete |
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WAYNESBORO-STAUNTON REGION--APPLICATION FOR MEMBERSHIP |
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Date_______________________________ |
| Name___________________________________ |
Birth month/day____________________ |
| Spouse's Name____________________________ |
Birth month/day____________________ |
| Address______________________________________________________________________ |
| City, State,
ZIP_______________________________________________________________ |
| Occupation_______________________________ |
Spouse's Occupation_________________ |
| Telephone Home_______________________ |
Business____________________________ |
| Cell____________________________________ |
E-mail_____________________________ |
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Make and year of antique or classic
automobile(s): (It is not necessary to own an antique automobile to be
a member.)
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| Special Interests:
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| Are you a member in good standing of the
National AACA? Yes________ No________ (You must be a
member of National AACA in order to become a member of a Region or
Chapter.) |
| National Membership Number
_________________________________________________ |
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Applicant's Signature
_________________________________________________________ |
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Members Recommending 1.
__________________________________________________ |
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2. __________________________________________________ |
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Annual Region Dues $15.00 |
Dues must accompany application. |
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Mail application to Mary Helen Ayers, Treasurer, 16 Ashleigh
Drive, Waynesboro, VA 22980 |
in the beautiful Shenandoah Valley of Virginia. Founded in 1950, it was the
1st Region in the South and the 4th Region in the Nation.