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