Membership Application

 

               VALLEY CRUISERS CAR CLUB                    

P.O. Box 4615

Rothesay, NB

E2E 5X3

 

 

Membership Application

Year ______________

Annual Dues : $25.00

 

Name: __________________________ Mate’s Name: __________________________

Street: ______________________________________________

City: ________________________________________________

Postal Code: _________________________________________

Telephone:   Home ____________________________

                    Work  ____________________________

                    Cell    ____________________________

Email: ________________________________________________

 

Web Address: www.valleycruisersnb.ca

 

Vehicles

                 Year                                        Make                                    Model

  1. ___________________________________________________________________
  2. ___________________________________________________________________
  3. ___________________________________________________________________
  4. ___________________________________________________________________
  5. ___________________________________________________________________