Membership Registration Form

Annual Dues: January through December $20.00 (Individual or household family)

If annual dues are paid after November 1st. of the current year, you will be considered
a current member through the end of the following Calendar Year.

New Member         Renewal

   
MCA Member?  Yes          No  
MCA#:                  
Expiration Date:  MM/DD/YY  
 

Member Last Name:

 Member First Name:   Middle Initial:
Date of Birth: Day:          Month :         Anniversary: Day:                                  Month :           
 
Spouse Information
Spouse Last Name: Spouse First Name:
Date of Birth: Day:          Month :
Spouse First Name:      
   

Address:

 
City:  
State:  
Zip:  
   
Phone Number:
Work Number:
Cell Number:
Email Address:
Do you prefer to receive your newsletter via email or US Postal Service (Check One)  Email     US Postal Service
Other Club Affiliation:                                           
 

Children's Names and Birthdates (under the age of 21 and still living at home)
Name: Birth Date: Day:  Month  Year:
Name: Birth Date: Day:  Month   Year:
Name: Birth Date: Day:  Month   Year:
Name: Birth Date: Day:  Month   Year:
Name: Birth Date: Day:  Month   Year:
       
How did you learn about the Oklahoma Mustang Club? 
       
Mustang Information  
Year:         
Body Style:   Coupe, Convertible, Fastback, Notchback, etc.
Model:   GT, Saleen, Shelby, Cobra, Roush, Steeda, etc
Engine    
Trans.    
Color    
Special Features: 
 
Second Mustang
Year:            
Model:             GT, Saleen, Shelby, Cobra, Roush, Steeda, etc
Body Style:   Coupe, Convertible, Fastback, Notchback, etc.
Engine:
Trans:         
Color:         
Special Features:
 
Third Mustang
Year:
Body Style   Coupe, Convertible, Fastback, Notchback, etc.
Model:   GT, Saleen, Shelby, Cobra, Roush, Steeda, etc
Engine:
Trans:
Color:
Special Features:
 
Forth Mustang
Year:
Body Style:   Coupe, Convertible, Fastback, Notchback, etc.
Model:   GT, Saleen, Shelby, Cobra, Roush, Steeda, etc
Engine:
Trans:
Color:
Special Features:
 

What are the reasons for joining OMC (Please rank in order of importance. 10 being most important)
Car Shows            Publications Social Events
Technical Information            Monthly Meetings Driving Events
Members Discounts            Assistance/Advice Opportunity to serve
Free webpage for your Mustang  Other:
 
 HAVE READ AND AGREE WITH ALL THE ABOVE STATEMENTS: Yes  No