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Membership Application

Houston Early Ford V-8 Club, Region 50

(Print out this form, fill out and mail to the address at the bottom)

 

Last Name

First Name

Year Joined

 

Name: ________________________________________________________________________________________
Name: ________________________________________________________________________________________
Street: _____________________________________________________________ Home#(____)_______________
City: ___________________________________ State_______ Zip_________ Office#(____)_______________
  Cell#(____)_________________
Children under 18 & Ages:_______________________________________________________________________
Web Site:______________________________________________________________________________________
E-mail:________________________________________________________________________________________

Early V-8 Information

Year

Body Style

Name

. . .
. . .
. . .
. . .
. . .
2018 Membership Dues per family--------------

$15.00

Additional Roster(s) @ $5.00 each ---------------------

______

Mail _____ Roster(s) @ $2.00 each --------------------------

______

  (Mailing of roster not included in membership fee)

Total $______

I the undersigned hereby agree, as a condition of my participation in Chapter activities, of the Houston Early Ford V-8 Club and Early Ford V-8 Club of America, that said participation is for my own pleasure and that I will be fully responsible for my car(s) and its passengers at all times.  I hereby release the Houston Early Ford V-8 Club and Early Ford V-8 Club of America, its assignees, officers, agents, officials and their successors from all liability whatsoever for any act, thing or event that might transpire during my membership. It is further agreed that vehicle(s) owned by the undersigned will at all times be operated by licensed drivers and said drivers will at all times comply with all applicable provisions of the licensing state.  In addition, it is agreed that all said vehicles would be properly licensed, insured and equipped in accordance with the licensing state.

Member Signature_____________________________________ Date______________  Spouse's Signature_______________________________________ 

National Club Membership  number _______________________ (must be a Early Ford V-8 Club of America member to be a member of a local club)

Please return this form with your payment. Make checks payable to Houston Early Ford Club. Dues must be paid by February 1, 2007 to be included in the roster and continue your "Flathead Newsletter". Dues may be paid at the club meeting or by mail.

Mail to:

Houston EFV8 Club

c/o Jerry Cantrell

12314 Wealdstone

Tomball, TX 77377