| 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
. . . . . . . . . . . . . . . .
|