AMERICAN MOTORS OWNERS ASSOCIATION APPLICATION

New Member _____ Renewal______ Former Member #_______AMO #__________

Name:____________________________________ Spouse: ___________________

Address: _________________________________________ Apt.#______________

City:________________________________________________________________

State/Prov/Parish:__________________________________ ZIP_______________

Phone & Area Code ___________________________________________________

E-Mail: (optional)_____________________________________________________

Other National or Regional AMC Affiliation if any:__________________________

Year Model                Engine    Transmission 
       
       
       
       
       

Dues are U.S.Members $ 35.00 per year,  Canada & Mexico Members $40 U.S. per year, Overseas Members $45.00 U.S. per year,  Vendors/Business $100.00 U.S. per year  Please Send a check or money order to: American Motors Owners Association, and mail it with this form to:

  American Motors Owners Association Inc.
c/o Cheryl Samuel

892 N. Jackson Ave.
Jefferson, WI. 53549
SPONSORING MEMBER: Eddie Stakes’ Planet Houston AMX