Last Name*

First Name*

Spouse's First Name

Address Line*

City*

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Zip Code*

Home Phone

Cell Phone

Spouse's Phone

Email Primary

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At which email address do you prefer to receive information from the chapter?

Are you a member of MAFCA or MARC National Model "A" Club? (Required for membership)*

Model A #1 - Year | Body Style | Running or Not?

Model A #2 - Year | Body Style | Running or Not?