Membership Application

Name_______________________________________________ Birthday-( Month/Day )___________________

Spouse/ Partner —First Name_____________________________ Birthday-(Month/Day)___________________

Address_____________________________________________

City_________________________________________ State___________________Zip___________________

Phone#- ( please Label Cell or Home)____________________________________________________________

Email Address______________________________________________________________________________

If you currently own a Model A’s please list them by Body Style- Model- Year—Owning a Model A is NOT Required to

Be A Member of Aiken Model A’s!!

Car #1 ________________________________ Car #2___________________________________

Car #3________________________________ Car #4____________________________________

Dues: Aiken Model A Dues is $25.00 yearly. ( Our Fiscal Year is July 1st-June 30th)

Please make out a check to “Aiken Model A’s” with this form to the Following: (Cash- only if you are delivering to a meeting, please)

Aiken Model A’s- PO BOX 992-Aiken, SC. 29802