Become 'A' Member

            

              Central Iowa Model A Club

 Application for Membership January-December

 Name ___________________________________ 

 Birthday (MM/DD) __________

 Spouse’s Name ___________________________

 Birthday (MM/DD) __________

 Street Address _____________________________________

 City ___________________________________

 State ______________                 Zip ________________

 Phone # ___________________________________

 E-Mail  ___________________________________________________

 Deliver my Newsletter (Check One);  In Color via E-Mail ____  

                                                   Black and White via Mail ____

 Model A’s Owned _______________________________________________

 Other Antique Cars Owned _______________________________________

 Please print and mail this form along with dues of $25 for the year to:

     Central Iowa Model A Club

     2624 E SHERIDAN AVE,

     DES MOINES, IA 50317

 

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This site was last updated 06/24/17