Copyright 2009 by AHOABC    All Rights reserved    E-Mail: webmaster@healeys.ca
AHOABC Renewal/New member Mail-In Form
Renewal
New Member Application
Name:
Address:
City:
Province/State:
PostalCode/Zip
Phone:
Email:
Cell:
# 1
Healey(s) you own
Make
Model
Year
Colour
V.I.N.
Driver?
# 2
Make
Model
Year
Colour
Driver?
V.I.N.
Dues -  Family membership is  $25.00 per year
Do you require a Name Badge(s)
Do you require a New Member Kit
Name Badge #2
Name Badge #1
Please indicate the name that you would like on your name badge(s)
Please charge    $                                   to the following Visa Card
Card #
Name on card
Expiry Date
If this is a renewal, please complete to allow for the maintenace of  accurate records
Cheque Enclosed
Charge to Credit Card Below
       We regret the only credit card we accept is Visa
Yes
No
Yes
No
Yes
No
Yes
No
(Spouse/Partner)
This form may be completed on your computer then printed and mailed, or
it may be printed then filled in by hand and mailed
#602 - 1641 Lonsdale Ave.,
NorthVancouver,B.C.
Canada, V7M 2J5
MAIL TO:
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Austin-Healey Owners Association of British Columbia
Mail in Form
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