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Heart of Virginia Classic Auto Club

Membership Application Form

Please 'Print Clearly' and complete the details required below:

1. Your Name: First . . . . . . . . . . . . . . . .  Last  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2. Address: Street . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . . . . . . . .

                  Town  . . . . . . . . . . . . . . . . . . . . . .  State . . . . . . Zip . . . . . . . . . . . .  . . . . . . . .

3. Telephone #: . . . . . . . . . . . . . . . . . . . . . . . E-mail:  . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4. Membership: (Please Circle)  Single  or  Joint   (If joint spouses first name) . . . . . . . . . . . . . . . . .

5. Membership Dues: (02-12-08)  Single $12.00 or Joint $18.00 per year.

6. Classic Vehicle: (If Any, Please Circle ) Car or Truck   Year . . . . . . . . . Model . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . Comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7. Do you know any of our club members? if yes, please enter their name (s) below:

Club Member (s). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Application; I/we wish to apply to join the Heart of Virginia Classic Auto Club, and I/we enclosed a check for $............ for the annual dues, and I/we understand and accept the Clubs Bylaws, and that our application is subject to being accepted, by a 'Yes' vote from the existing members.

 

Signature . . . . . . . . . . . . . . . . . . . . . . .  . . . Date . . . . . . . . . . . . . . . .
 

Please mail your application with your 'dues' check to:

H.O.V.C.A.C
Or call
Irene Dunn - (434) 696-2266

Secretarial Records

Club Meeting Vote

Yes       No

Date:
 
Secretarial Notes/Action: