The ANTIQUE AUTOMOBILE CLUB of AMERICA
Westerly Pawcatuck Region
APPLICATION
FOR
MEMBERSHIP
For additional information you can contact Membership Chairman Ernie Cormier ~ call: (401) 539-2547
PLEASE PRINT LEGIBLY
| Name: |
Birthday |
Anniv |
| Spouse's name |
Birthday |
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| Child(ren)'s name |
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| Mail Address |
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| City/State/Zip |
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| email address |
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| Home Phone |
Business Phone |
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| Sponsor (Optional) |
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| AACA Number* |
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| Antiques Vehicles Owned (Optional) |
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| Year/Make |
Model |
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| Year/Make |
Model |
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| Year/Make |
Model |
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| Note: Ownership of an automobile is not required for memberhip but membership in the National is required. |
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| Signature |
Date |
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| Mail application with $15 dues to:
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| Laura DeGoursey |
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| 49 Tom Wheeler Rd. |
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| North Stonington, CT 06359 |
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| Make checks payable to: Westerly Pawcatuck Region AACA |
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