FALCON CLUB OF AMERICA

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APPLICATION FOR MEMBERSHIP

WHEAT STATE Chapter of the FALCON CLUB of AMERICA

     The Falcon Club of America is a non-profit club that was founded in 1979.  The club is an international club of more than 3000 members.  The club is for individuals or families that are interested in the restoration of the Ford Falcon automobiles that were manufactured from 1960 to 1970.

     The Wheat State Chapter is a chapter of the Falcon Club of America and is chartered to serve the Falcon owners in the Wichita & South Central Kansas area.  The Chapter is a non-profit club, registered with the Newton, Ks. Chamber of Commerce to function as a car club hosted out of Newton.  This Chapter is a family oriented club that provides much enjoyment for the members along with the emphasis upon the Falcon.  There are yearly dues and a chapter newsletter that is published every other month (odd).  Meetings are scheduled regularly with one meeting every other month (even) and one car show per year.  The meetings are held in different locations throughout the area offering opportunities for all members to attend. 

Please Print:

NAME:___________________________________

Home Phone:_____________      (listed/Unlisted)

Birthday (Month&Day ):____________________

Address:_________________________________

Work Phone:________________

City:____________________State:____________

Zip Code:______________

E-mail Address:____________________________

Spouse / Significant other name:______________

Birthday  (Month & Day):__________

Anniversary Date:___________

Children(s) Name(s)________________________________________________

Falcon(s) Owned:__________________________

Other Car(s) &/or nterest:_____________________

Dues for this year (Wheatstate and FCA)  : $40.00