FEDA MEMBERSHIP APPLICATION
Name ________________________________________________Membership #___________
Mailing Address ______________________________________________________________
City, State, Zip _______________________________________________________________
Home Phone ____-____-_____ Can we publish this? Yes __________ No ____________
Work Phone ____-____-_____ Can you be called at work? Yes _________ No __________
E-Mail Address_______________________ FAX Number _______-________-____________
Present Car-Chassis__________ Year ________Wheelbase _______________
Engine-Make_________ Size_______ Induction _________Fuel __________________
Special Features__________________________________________________________
Transmission-Type ____________________# of Gears___________ Ratios _______________
Clutch/Converter ______________________ # of Plates/Stall Speed______________________
Are you an Owner, Driver, Crew member, Enthusiast? _________________________________
Comments about your wishes or desires from FEDA, and/or just to tell us more about yourself:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Mail this form to: FEDA FEDA c/o Bob LaFrentz
346 Hawthorne 408 Hummingbird Ct.
Bensenville, IL 60106 Deerfield, IL 60015
630-860-7491
Name ________________________________________________Membership #___________
Mailing Address ______________________________________________________________
City, State, Zip _______________________________________________________________
Home Phone ____-____-_____ Can we publish this? Yes __________ No ____________
Work Phone ____-____-_____ Can you be called at work? Yes _________ No __________
E-Mail Address_______________________ FAX Number _______-________-____________
Present Car-Chassis__________ Year ________Wheelbase _______________
Engine-Make_________ Size_______ Induction _________Fuel __________________
Special Features__________________________________________________________
Transmission-Type ____________________# of Gears___________ Ratios _______________
Clutch/Converter ______________________ # of Plates/Stall Speed______________________
Are you an Owner, Driver, Crew member, Enthusiast? _________________________________
Comments about your wishes or desires from FEDA, and/or just to tell us more about yourself:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Mail this form to: FEDA FEDA c/o Bob LaFrentz
346 Hawthorne 408 Hummingbird Ct.
Bensenville, IL 60106 Deerfield, IL 60015
630-860-7491
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