Renewal
New Member Application
Name:
Address:
City:
Province/State:
PostalCode/Zip
Phone:
Email:
Cell:
Healey(s) you own:
Make
Model
Year
Colour
V.I.N.
Driver?
# 2
Make
Model
Year
Colour
Driver?
V.I.N.
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 credit card
Card #
Name on card
Expiry Date
If this is a renewal, please complete to allow for the maintenace of  accurate records
Charge to Credit Card Below
Yes
No
Yes
No
Yes
No
Yes
No
(Spouse/Partner)
MAIL TO:
Print Page
Austin Healey Owners Association
of British Columbia
#602 - 1641 Lonsdale Ave.,
North Vancouver, B.C.,
Canada, V7M 2J5
Austin-Healey Owners Association of British Columbia

Mail in Form
Dues -  Family membership is  $25.00 per year
Cheque Enclosed
This form may be completed on your computer then printed and mailed, or it may be printed then filled in by hand and mailed
# 1