Please note:
This form will not give you information about a particular car.
It is for owners to report ownership and other changes.

NAME:
ADDRESS:
CITY: STATE: ZIP:
PHONE:
E-MAIL:

Please note: Addresses and phone numbers are for internal club use only. Only names, cities, and states (or countries) appear in the Registry. If you would like your name withheld from the next edition of the Registry then please check this box.

 

ORIGINAL DEALER (if known): 

MODEL (as designated by the factory):    Street   Other  

ORIGINAL COLOR	INTERIOR
Red Maroon Blue Charcoal White Green Other:	Black Red

PRESENT FEATURES (as car is today)		ORIGINAL FEATURES (as car left factory)
	427 V8
	428 V8
	4-speed transmission
	automatic transmission
	Sunburst wheels
	6-spoke FIA Halibrand mags
	GT40-type Halibrand mags
	other mags:
	hood scoop
	roll bar
	oil cooler scoop
	side exhaust
	narrow rear fenders
	standard (slightly flared) fenders
	competition rear flares
	S/C rear flares (extra lip)
	competition gas cap
	chrome tube bumpers
	competition quick jack pads
	1x4V induction system
	2x4V induction system
	Weber induction system
	dry sump oiling system

PRESENT COLOR:

PRESENT CONDITION:	5. undergoing restoration
1. original/unrestored	6. wrecked
2. original/restored	7. destroyed
3. modified/unrestored	7. parted-out
4. modified/restored	9. rebodied

THIS IS NEW INFORMATION TO SAAC (as far as I know)
THIS IS A CORRECTION TO THE LATEST REGISTRY
THIS IS AN ADDITION TO THE LATEST REGISTRY
I DON'T KNOW IF MY CAR HAS BEEN IN A PAST REGISTRY


PAST OWNERS: Please list past owners from first to present in
chronological order (use question marks to indicate unknown owners).

INDIVIDUAL HISTORY: List, in chronological order, anything
unique to this car or its owners.


     

Your information will be emailed to the registrar.

COBRA REGISTRAR: NED SCUDDER 397 INDIES DR VERO BEACH, FL 32963 FAX 619-551-4313 EMAIL nedscudder@gmail.com