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Ford Galaxie Club of America
member application or renewal (member number)

Date:   E-mail:
Name:
Address:
City: State (PROV):
Country: (Postal Zone) Zip+4:
Telephone: Can we put this in the club roster? Yes: No:
Are you willing to help a stranded member (within reason)? Yes: No:
Do you own a Galaxie? What year(s):
What model(s):
If you have more than one, let us know what engines, transmission, and body types so we can keep this on file for our parts data base for you to use.
I am interested in the following club services: Shows-
Galaxie Gazette Magazine-
Parts Interchange Information-
Technical Service- Parts Location Service-
Being part of the technical information committee-Yes: No:
Free classified ads, 3 times a year-(this includes WWW exposure)
Member recommendation service-
(any problems you have with a vendor or parts supplier, let us know and it is kept on record for other members. Sort of like BBB)
The member registry (Buddy Book) is available for
$11.00 to cover postage and printing
CD-ROM Shop manual
$52.00
FGCoA Restoration Resource Book
MEMBER price: $25.00
Club cap with embroidered logo available for
$12.00
pick cap color: dark blue, red, black,
T-shirts: S, M, L, XL $18.00 XXL $20.00
Heavy gauge aluminum sign - "Ford Galaxie Parking Only" - all others will be recycled printed in red and white on 3M reflective backing.
$30.00
Please send a photo of your Galaxie(s) so we can keep in on record and place it on the Internet.
(Subject to quality of picture approval.)

Sorry, we CANNOT accept charge cards or any funds other than those denominated in US "Dollars".
PLEASE NOTE: ALL CANADIAN AND OVERSEAS ORDERS FOR CLUB PRODUCTS MUST CONTACT US BY PHONE
OR E-MAIL FOR EXACT SHIPPING CHARGES
Please read our statement of purpose and then mail completed application with fee and photo to:

rev.4/07   Total sent:  

Ford Galaxie Club of America
P.O. Box 429
Valley Springs, Arkansas 72682-0429
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