Last Name*
First Name*
Spouse's First Name
Address Line*
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Zip Code*
Home Phone
Cell Phone
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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?