Make checks payable to the Mustang Club of Ohio and send this form to:

                     Member Name  

Additional Family Members  

                                Address     

                                       City   

                                     State      Zip   Phone: () -

                   Email address   

Can we publish your name and information in the Club Directory?    Yes No

All information above this line is required for your application to be processed

Are you a member of Mustang Club of America?    Yes No

If you are a member of MCA, please include your MCA number   

Please list the Mustang(s) you own:

     YEAR            MODEL (Conv, Coupe, Fastback, Shelby)                 COLOR