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Name:            &nbs= p;=20            &nbs= p;            = ;            =             &= nbsp;           &n= bsp;           &nb= sp;           &nbs= p;            = ;            =             &= nbsp;         =20

Address:         =20            &nbs= p;            = ;            =             &= nbsp;           &n= bsp;           &nb= sp;           &nbs= p;            = ;            =             &= nbsp;         =20

City:               &nbs= p;            = ;            =             &= nbsp;           &n= bsp;          =20      =20 State:   =20            &nbs= p;    =20     =20 Zip:     =20            &nbs= p;       =20

Home Phone:       =20            &nbs= p;            = ;            =            =20      =20 Cell Phone:      =20            &nbs= p;            = ;            =           =20

Pager:     =            &nbs= p;            = ;            =             &= nbsp;           &n= bsp; =20      =20 Fax:    =20            &nbs= p;            = ;            =             &= nbsp;          =20

E-Mail:      =            &nbs= p;            = ;            =             &= nbsp;           &n= bsp;           &nb= sp;           &nbs= p;            = ;            =             &= nbsp;           &n= bsp;   =20

Significant Other:      =20            &nbs= p;            = ;            =             &= nbsp;           &n= bsp;           &nb= sp;           &nbs= p;            = ;            =           =20

Children:      =            &nbs= p;            = ;            =             &= nbsp;           &n= bsp;           &nb= sp;           &nbs= p;            = ;            =             &= nbsp;           &n= bsp;=20

Birthdates (mm/dd) =96=20 Husband:   =            =20      =20 Spouse:         =20           =20 Anniversary (mm/dd)     =            =20

 

What type of work do (or did) you = do?           &nbs= p;            = ;            =             &= nbsp;           &n= bsp;           &nb= sp;           &nbs= p;       =20

 

Type of Model =91A=92 you have?             &nbs= p;            = ;            =             &= nbsp;           &n= bsp;           &nb= sp;           &nbs= p;            = ;        =20

 

Is your Model =91A=92 drivable?              &nbs= p;  =20         =20 M.A.F.C.A. member?              &nbs= p;            = ;            =           =20

 

How did you find out about our activity = today/this=20 evening?           &nbs= p;            = ;            =             &= nbsp;         =20

      =            &nbs= p;            = ;            =             &= nbsp;           &n= bsp;           &nb= sp;           &nbs= p;            = ;            =             &= nbsp;           &n= bsp;           &nb= sp;   =20

 

Would you like to be informed of = upcoming=20 events?   =            &nbs= p;            = ;            =             &= nbsp;           &n= bsp;       =20

 

Do you know others that have an interest = in Model=20 A=92s? List Name, Address & Phone = Number:

      =            &nbs= p;            = ;            =             &= nbsp;           &n= bsp;           &nb= sp;           &nbs= p;            = ;            =             &= nbsp;           &n= bsp;           &nb= sp;   =20

 

If you=20 join our club:

      = Would you=20 be willing to help with Club Activities?             &nbs= p;            = ;            =             &= nbsp;           &n= bsp;    =20

 

Membership=20 - $25 (You may=20 join after attending three events - ie: meeting,=20 parade, tour, etc).=20 This=20 membership is for both husband and wife. Both enjoy voting = privileges.=20 This membership will receive one copy of THE STEERING COLUMN = newsletter=20 monthly. Dues are billed annually for the Club=92s fiscal year = beginning=20 DECEMBER 31st.  Memberships conferred after October 1 = includes all of=20 the succeeding year. There is no prorating of fees for late = memberships=20 and no back issues of THE STEERING COLUMN are=20 supplied.

Make=20 your check payable (U.S. Funds) to Paradise Valley Model A Club or PVMAC

ANY=20 CHECK DISHONORED BY A BANK AND RETURNED TO PVMAC WILL BE SUBJECT = TO A=20 CHARGE OF $30.00.
Top=20 of Form

Area=20 below for Membership Committee Use = ONLY

 

 

Date

What/Where

#1 Activity=20 attended

 

 

#2 Activity=20 attended

 

 

#3 Activity=20 attended

 

 

Voted Into = Club

 

 

Dues paid to=20 Treasurer

 

 

Badge = Ordered

 

 

Badge = Presented

 

 

Revised January=20 2006

 

Please=20 bring to meeting or mail this form = to

 PVMAC,=20 P.O. Box = 1120,=20 Rialto, Ca.=20 92377

 
           &nbs= p;     =20     =20 Application for = Membership