Date:

Requesting Membership for 2024:
—Please choose an option—New MemberRenewal Membership
Card #

Are you a current member of the Mustang Club of America?:
—Please choose an option—YesNo
Card #

Your Name:

Other members of your family for membership cards:

Address:
City:   State:   ZIP:

Home Phone:    Cell Phone:

Your email:

Car Status:
—Please choose an option—Own Completed FordBuilding FordPlanning to BuildEnthusiast

Details of your primary hobby car:
Year:    Make / Model: Color:

How did you hear about us?
—Please choose an option—InternetWord of MouthOther
If Other, where?:

I acknowledge and understand the items listed on the Membership Application. I will not hold the
Midwest Blue Oval Club responsible for any liability arising from my driving or my car. I will abide by
the By-laws of the Midwest Blue Oval Club.

Accept

Please send payment & application to:

Midwest Blue Oval Club, ATTN: Fran Rutherford,
10906 S Perdue Rd, Grain Valley, MO 64029
Or pay by paypal: MBOCregpay99@gmail.com