NAME SPOUSE

ADDRESS

CITY STATE ZIP

TELEPHONE e-MAIL

YEAR OF THE CAR BODY STYLE

If more than one "T", list below:

YEAR OF THE CAR BODY STYLE

YEAR OF THE CAR BODY STYLE

Member - Model T Ford Club of America? Yes Membership No.

Member - Model T Ford Club International? Yes Membership No.
You must be a member of the Model T Ford Club International to Tour with us.

SIGNATURE _____________________________ DATE __________________

Print this page and mail the completed application and membership dues of $10.00 to:

Model T Ford Club of Central Florida

Send to:
Wanda Johnson, Treasurer
1173 Palos Verde Drive
Orlando, FL 32825

Copyright© 2004 -Modet T Ford Club of Central Florida - All Rights Reserved