Antique Automobile Club of America
Wayne - Pike Region A.A.C.A.
Membership Application
Name_____________________________ Spouse________________
Address__________________________________________________
City , State , Zip___________________________________________
Phone___________________________ Email__________________
Birthday (Not Year)________________________________________
Occupation_______________________________________________
National AACA Membership #________________Letter__________
You have to be a member of the National AACA
Our Dues are $10.00 , Payable to Wayne-Pike Region A.A.C.A.
Make if Vehicles ( Antique or Classic) list 3-4 vehicles & Include Models , style, year & Color if you want a picture posted in our gallery of these vehicles send them to ;
Mark Golding AACA Gallery 2000 Bethany TPK, Pleasant Mount, Pa 18453
or e-mail them to markgold@nep.net please put AACA gallery in subject box.
Vehicle # 1_______________________________________________
Vehicle # 2_______________________________________________
Vehicle # 3_______________________________________________
Vehicle # 4_______________________________________________
DUES MUST ACCOMPANY THIS APPLICATION
Mail to;
Mandy Koenig
RR 2 , P.O. Box 455
Hawley , Pa. 18428