CAPITOL CITY FORD AND MUSTANG CLUB
Membership Form
(January 1st through December 31st, 2009)
Your Name: _____________________________________ Birthday_______________
Occupation: _______________________________________________________Spouse's Name: __________________________________ Birthday_______________
Occupation: _______________________________________________________Address: ________________________________________________________________
City: _________________________________________ State: ______ Zip: __________
Phone: (_____)____________________ Cell Phone: (_____)____________________
E-Mail Address: _________________________________________________________
Names of Children: (Please list all of your children; but if they are in school, including
college, please list birthday.)
(1)________________________________________ Birthday_______________(2)________________________________________ Birthday_______________(3)________________________________________ Birthday_______________(4)________________________________________ Birthday_______________Club Car(s):
(1) Year_____________ Make/Model__________________________________(2) Year_____________ Make/Model__________________________________(3) Year_____________ Make/Model__________________________________Which Club Activities Would You Like to Help Organize?
Car Shows_____ Picnic_____ Swap Meet_____ Cruises_____Show/Shine_____ Officer_____ Photographer_____ Newsletter____Welcome Committee_____ Other____________________________________________________________________________________________Year You Joined CCFMC__________ Paid Membership: $15.00_________
PLEASE RETURN MEMBERSHIP FORM AND DUES TO:
Capitol City Ford and Mustang Club
P.O. Box 57001
Lincoln, NE 68505
What is Your Main Reason for Joining CCFMC?_____________________________
____________________________________________________________________________________________________________________________________Other Organizations to Which You Belong:__________________________________
____________________________________________________________________________________________________________________________________MUSTANG CLUB OF AMERICA INFORMATION
Member (Y)______(N)______ MCA Number: ________________ Since: _________
Certified Judge Gold Card Judge (Y)__________(N)___________ Years:____________
DATE APPROVED FOR MEMBERSHIP: ____________________
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**We may be compiling a Pictorial Membership Book and CD. We would like to
include pictures of you, your family, and your club cars in the book and CD.
The following information about your car would be included:
Club Car Profile:
Year/Body Style: ____________________________________________________Engine: ___________________________________________________________Exhaust: ___________________________________________________________Suspension/Rearend: _________________________________________________Exterior/Interior: ____________________________________________________
Special Notes: ________________________________________________________________________________________________________________________**If you have more than one club car, please include the information on another sheet of paper.
Would You Prefer a Pictorial Membership: Book__________ CD_________
