Annual dues are $10.00, plus a one time $15.00 initiation fee.  You will receive your Vintage Bird Chapter name badges.  Please state how you would like your name(s) to appear on the badge(s).

Name:  ____________________________________

Name:  ___________________________________

Send check for $25.00 with this application to: 
Robert Dilks, Treasurer
 Vintage Birds Chapter
 HC 70 Box 1305
 Kingston, OK, 73439

Name(s): ________________&_________________________________
Street: __________________________________________________
City: __________________________________________________
Phone: (___)____-______ Cell (___)____-______
Email ___________________________________________
Year: 19___ Type:__________________ Chassis
No.:________

I am a paid up member in good standing of FMCA and wish to become a member of the Vintage Birds Chapter.
  
Signed: _______________________________________
My FMCA # is: ____________