MEMBERSHIP APPLICATION
GEORGIA REGIONAL GROUP #24 EARLY FORD V-8 CLUB

Name ___________________________________ Birthday (month/day) __/__

Spouse Name ______________B’day (m/d) __/__ Anniversary (m/d) __/__

Address ________________________________________________________

City _______________________________ State ______ Zip ____________

Phone ______________ e-mail _____________________________________

Vehicles Owned year model body style engine running condition
                           1__________________________________________________
                           2__________________________________________________

Annual dues $20.00, prorated as follows: 4/1 $15.00, 7/1 $10.00, 10/1 $5.00.
Please fill out, enclose your check and mail to:
GA Regional Group#24, 3400 HIDDEN ACRES DRIVE, ATLANTA, GA 30340

Ownership of an Early Ford V-8 is not required.