APPLICATION FOR MEMBERSHIP
Please complete and print the membership application below. Please return this application form to the address below. You must belong to the national AACA in order to join the Central Illinois Region.

Date:
Name: Spouse First Name:
Address:
City: State: Zip:
Phone (home): Phone (cell):
Email:
AACA National Membership #:

Make and Year of Classic, Antique Vehicle, Motorcycle, or Other
(It is not necessary to own a vehicle to become a member)

Year: Make: Model:
Year: Make: Model:
Year: Make: Model:

The Annual Dues are:
- Central Illinois Region: $20.00
- Antique Automobile Club of America: $35.00 (If you are not a current member)

Please print completed form and make check payable to Central Illinois Region AACA
Mail payment to: Ed Brown | 2708 Killarney Rd. | Springfield, IL 62711