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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)
FGCoA Restoration Resource Book DVD
MEMBER price: $20.00
1984-2012 Magazines DVD
MEMBER price: $30.00
1984-2012 Magazines + FGCoA Restoration Resource Book DVD
MEMBER price: $45.00
Club cap with embroidered logo available for
$12.00
pick cap color: dark blue,OUT OF STOCK red, black, OUT OF STOCK
T-shirts: S, M, L, XL, XXL, XXXL, $35.00 each Quantity:
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.)

  • Annual membership is $40.00 for American and $40.00 for Canadian (US Funds) applicants which includes all of the named services, and a bi-monthly issue of the Galaxie Gazette sent barcoded-presort in the US and 1st class to Canada. Other countries (overseas) membership is $55.00 in U.S. Funds (Postage is currently over $4.00 US for each issue sent overseas.)
    3 year memberships are available for $100 SAVE $20
    Life Memberships are available.
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.11/13   Total sent:  

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