Lone Star Model A Ford Club
Membership Form

For changes, just fill out the first couple of lines and then just the changes

First name:    Spouse; First name:
Last name:Last name:
Occupation: Occupation:
(If retired, please so state and indicate former profession)
Work Phone: Work Phone:
Cell Phone: Cell Phone:
Email: Email:
CB Handle: CB Handle:
Birth Month and Day:Birth Month and Day:
Home Phone:
Address:City: State: Zip:
Model A's
Year:     Body Style:     Restored Unrestored    Nickname
Year:     Body Style:     Restored Unrestored    Nickname
Year:     Body Style:     Restored Unrestored    Nickname

Lone Star Model A Ford Club dues are $20 per calendar year and are due in December for the following year. Dues are prorated based upon when you join the club. Please use the following schedule for the amount of dues to pay:

January$20.00 February$18.33March $16.67 April $15.00May $13.33June $11.67
July$10.00 August $  8.33 September $  6.67 October$  5.00 November$  3.33 December$  1.67

Dues$20.00 for a full year
Additional Rosters at $2.00 each:$
Mailing Roster: $ 3.00                                         "Make check payable to LSMAFC"
Total Amount Enclosed: $

We recommend that if you join the club in August or later that you include the following year's dues ($20) to your first year's dues. Otherwise, another dues payment will become due in December for the following year. If you want your roster mailed to you, please add $3.00 for postage. Your dues include one free club roster; additional rosters are $2.50 each.

After filling out the form, you may "submit" it to and bring
your check to a monthly meeting or to the Saturday morning breakfast
at Georgetown IHOP. Or, you may print it and mail it with a check to:
LSMAFC Membership Chairman
3404 INDIAN MOUND RD
GEORGETOWN, TX 78628-1220