MEMBERSHIP RENEWAL 2011

 

FULL NAME __________________________________ PARTNER ____________________________

RESIDENTIAL ADDRESS AND POSTAL ADDRESS (if different)

_______________________________________________________________

_______________________________________________________________

TELEPHONE NUMBERS

Home (    ) ________________________ Cellphone (      )________________________

Business (    )_____________________  Email ________________________________

I/We hereby apply for membership of The Austin-Healey Car Club of New Zealand Inc. Upon acceptance, I/we agree to abide by the Rules of the Club.I enclose my/our cheque for $50.00

Signature: ______________________          Date:  _____________________

AUSTIN-HEALEY OWNERSHIP DETAILS

Year: ___________________     Exterior Colour: _________________

Model: __________________    Interior Colour: __________________

Reg. No: _________________  On/Off Road: ____________________

SUBSCRIPTIONS:      Subscription rates apply to the financial year ending 31 December. Please indicate if you are a Life Member and return the renewal form to the club for details update.

SUBSCRIPTION RATES: New Zealand Membership: $50.00, Overseas: Upon Application, Life Membership: $00.00

Please print, complete and post with payment to: P O Box 6077, Brookfield, Tauranga 3146

FOR CLUB USE:   Date received:                Amount received :                Membership Secretary :               Actioned by: