Ford Salaried Retirees Club

Membership Application Form

I wish to join the Ford Salaried Retirees Club.

Circle or Check one: Mr.___ Mrs.___ Miss ___ Ms ___

Name: ______________________________________________________________




Postal Code:__________________Phone#:__________________________________

Spouse's First Name:___________________________

E-mail Address:_____________________________________________________

Date Retired:_________________Dept/Plant Last Worked:_____________________

I would be interested in serving as an officer of the club : Yes ____ No ____

I would be interested in serving on a committee: Yes ____ No ____

State any committee preferences: ______________________________________

Dues $20.00 (annual0 $200.00 (lifetime) Canadian Funds or Equivalent

Make cheques or money orders payable to: Ford Salaried Retirees Club

Signature:______________________ Date: ____________________

Please mail the completed form with your dues to:

Ford Salaried Retirees Club
The Canadian Road
Oakville ON
L6J 5E4