Mail In New Membership / Renewal form

Please either complete this form and print it or print it and complete by hand and mail to the address indicated.
Mail In Membership Application
Renewal
New Member
NAME
ADDRESS
CITY
POSTAL CODE
PHONE
CELL
EMAIL
Make
Make
VIN
VIN
Year
Year
MAIL TO:
Please charge  $       
to the following Credit Card
VISA
Master Card
Card #
Expiry Date
Name on Card
This form may be completed on your computer, then printed and mailed OR it may be printed and completed by hand
Austin Healey Owners Association of British Columbia
#602 - 1641 Lonsdale Ave.,
North Vancouver, B.C.
Canada , V7M2J5
PROV/STATE
Healey(s) you own. If this is renewal, please complete below if there is a change in vehicle status
#1
#2
Model
Model
Colour
Colour
Driver?
Driver?
Do you require a Name Badge?
Do you require a New Member kit?
Dues - Family membership is $25 per year
Cheque enclosed
Charge to Credit Card below
2019/03/22