MEMBERSHIP APPLICATION

ST. CLOUD ANTIQUE AUTO CLUB, INC.

NAME: last__________________________________first____________________________spouse___________________________

Date:__/__/____

Children under 18___________________________________________________________________________________

ADDRESS___________________________________city________________________state______zip_____________

EMAIL ADDRESS__________________________________________________

TELEPHONE(______) _________________________

Occupation: (No Business Names)__________________________________

DUES: one year Family (w/spouse&children under 18) $20.00
new member first year $20.00 or if your membership lapses for more then 1 year
$1.00 for mailed rosters

List your antique, street rod, and / or collector automobiles now owned:

YEAR

MAKE

MODEL

BODY STYLE

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List other auto related collectibles of interest.