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Please print out, complete and mail this form with your
membership dues to the address below. You MUST have a national
membership number BEFORE applying for membership to any regional club.
Any applications received without the national number will be pended.
Thank you.
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MASON-DIXON REGION A.A.C.A. APPLICATION FOR MEMBERSHIP ________________________________ ______________ _________________ Name of Applicant Birth date Occupation ________________________________________ __________________ ______________________ Spouse Birth date Occupation ________________________________________________ ________________ ________________ Address Telephone Number Application Date ___________________________________________________ _______________________________ City State Zip Sponsoring Member (Optional) Make and year of Antique or Classic Automobile(s): Special Interests: (it is not necessary to own an automobile to be a member)
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____________________________ A.A.C.A. National Membership Number: __________________ ____________________________ (You must be a member of National A.A.C.A. to become a Date accepted for membership member of a region and applicants for joint membership must be joint members of National A.A.C.A.)
Applicant's Signature: _________________________________ Mail Application with dues to: Betty Sterner, Treasurer 325 Suelinn Drive, Chambersburg, PA 17201-8287 Annual Dues: $14 Individual - $14 Joint (Dues must accompany application) |