Chapter Application

Chapter Application

Falcon

AUTOMOBILE

1960 THRU 1970

APPLICATION FOR MEMBERSHIP

Falcon Club of America

NORTHEAST CHAPTER

NAME: _______________________________________ SPOUSE __________________________________

ADDRESS: ______________________________________________________________________________

CITY: _________________________________ STATE: _________ ZIP: _____________

TELEPHONE: __________________________ NATIONAL FCA MEMBER # ______________

REGIONAL FCA MEMBER # ______________

E-MAIL ADDRESS: ______________________________WOULD LIKE NEWSLETTER VIA EMAIL_______

TELL US ABOUT YOUR CARS:

PLEASE LIST FALCONS YOU OWN PLUS ANY ADDITIONAL COMMENTS ON THE BACK OF THIS APPLICATION.

YEAR MODEL BODY STYLE COLOR

CAR # 1 ______________________________________________________________________________

CAR # 2 ______________________________________________________________________________

LIST OF CAR CODES

CV - Convertible SCP - Sport Coupe RCO - Ranchero

HT - Hardtop SW - Station Wagon SQ - Squire Wagon

EV - Econo. Van SHT - Sprint Hardtop SCV - Sprint Convertible

F - Futura 2S - 2 dr. Sedan 4S - 4 dr. Sedan

Note: Membership in the FALCON CLUB OF AMERICA (national) is required prior to membership in any local chapter.

Regional Chapter Annual Dues are $10.00 per year, $18.00 for 2 years, renewable in June.

Note: for members joining mid-year dues are pro-rated as follows: If joining between

Make check payable to: 1 year 2 years

June - Sept. $10.00 $18.00

NORTHEAST CHAPTER FCA Oct - Dec. $ 8.00 $15.00

Send Application and Dues to: Jan - Mar $ 6.00 $13.00

Apr - May $12.00 - 1+ year $20.00 - 2+ years

Bill Warburton, Treasurer

740 Tunk Hill Rd., Hope, RI 02831