EDSEL OWNERS CLUB, INC.

Membership Application
[ Please make a selection. ] NEW
[ Please make a selection.] RENEWAL

  Name ___________________________________________________
  
  Address ___________________
  
  City ___ State __ Zip __  Telephone __
    
  E-Mail Address __  Referred By: __
  This is a change of adress [Please make a selection.]                                                                     

LIST EDSELS OWNED
Include "Parts" Cars

Year        ___________ ___________ __________ ________ ___________
  
Model       ________ ________ _______ _____ _______
  
Body Style     ___ ___ ___ ___ ___
(sedan,hardtop,convertible,wagon)                                                                    
Serial No      _____ _____ _____ _____ _____
  
Color(s)    __ __ __ __ __
Purchased   __________ __________ __________ __________ __________
(New or Used)                                                                                        
  
Engine/         __ __ __ __ __
Transmission                                                                                      




*Use       __ __ __ ___ ___
                     *Show car, parts car, transportation, excess, etc.  
 

I _ _ hereby apply for membership in the EDSEL OWNERS CLUB, INC. and have enclosed Annual Dues: $35 for US members, $40 for Canadian members (US Funds), $45 for Foreign members (US Funds). NOTE - DUES OPTION: $25 for US members, $30 for Canadian members, $35 for International members IF you choose to have your newsletter sent by e-mail.  Save $10.00 !! Please assure your email is printed clearly above. An Associate Membership gives all club rights and privileges, with the exception of receiving club publications, to any family member or companion over the age of 16 who resides in the same household as a regular member. Associate membership are available for $15 per year US funds.

Signed __________________________________________ TOTAL REMITTED $____ _________

Mail to: Lois Roth, Edsel Owners Club, Inc.
1740 N. W. 3rd St., Gresham, OR 97030
Telephone: 503-492-0878


Internet Registration Form Rev I-0516, http://www.edselclub.org/member.html