GATEWAY CHAPTER
FALCON CLUB of AMERICA
MEMBERSHIP APPLICATION
$1.25 per month



NAME ______________________________________________________SPOUSE_________________

ADDRESS____________________________________________________________________________

CITY_____________________________________STATE_________________________ZIP__________

TELEPHONE__________________________________________________________________________

E-MAIL ADDRESS______________________________________________

PLEASE LIST ANY FALCONS YOU OWN BY YEAR AND BODY STYLE:

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________


WHAT CLUB ACTIVITIES INTEREST YOU? TOURS_______CAR SHOWS______

SWAP MEETS____ SOCIAL ACTIVITIES_____ OTHER ACTIVITIES__________________________

ADDITIONAL ACTIVITIES RELATED TO THE CAR HOBBY OR OF SPECIAL SIGNIFICANCE TO

YOU:_________________________________________________________________________________

______________________________________________________________________________________

Would you like your name, address and phone number to appear in a club roster which is furnished to each

Member? YES_____ NO_____


Dues are $15.00 each year.
Make check or money order payable to: Gateway Chapter FCA

Return completed application to: Gateway Chapter FCA
C/O Jay Introcaso
225 Bates, Apt B
St. Louis, Missouri 63111

Meetings are held the 4th Sunday of each month.

For additional information contact: Rich Albert: 636-677-4670
Jay Introcaso: 314-537-6141

Membership Form
Print out and mail