Central Arkansas Pickups Application Form
Yes !! I want to become a member of Central Arkansas Pickups
Name:
Spouse's Name:
Mailing Address:
City / State / Zip:
Phone:
email:
Full Membership  $30 per year
Associate Membership        Click Here for dues schedule $12 per year
Return this application along with a check or money order payable to Central Arkansas Pickups at: 

Central Arkansas Pickups
903 College St.
Kensett, AR 72082

Note: The ownership of a Ford Truck  IS NOT a prerequisite for membership.

  

Please List Below Any Trucks That You Own

Year
 Model
Color
19___
    
19___
    
19___
    
Signature:  Date: