| Your Name: | Your Birthday: |
| Spouse Name: | Spouse Birthday: |
| Mailing Address: | City: State: Zip: |
| Phone: | Email: |
| Is this a Renewal: New Membership: | |
| Do you own a Mustang? Yes: No: | (Note: ownership is not required) |
| Year | Model | Color | Stock | Modified |
| What Are your Interests (Check all that apply): | Restoration Parts Discounts Locating Parts Social Activities Cruises\Road Rallies Car Shows Other |
Dues are pro-rated based upon when you join the club. January - June $ 20.00, July - August $ 15.00, September $ 10.00, October - December $5.00 or you may pay $20.00 which includes the next calendar year!
Please Fill Out Form, Print, and Send To: