Escort Car Club
P O Box 212
Epsom
Auckland
E-mail: eccnz@hotmail.com
www.eccnz.org

Escort Car Club Inc

MEMBERSHIP APPLICATION




Name: 
Address: 
  
Ph: Hm Wk Mob 
Email: 
Car (make, year & model): 
Reg No.: Colour: 
Occupation: 


I agree to observe all rules of the Escort Car Club that are presently in force and as may be adopted from time to time. I understand that the membership year runs from August to August and that my next subscription will be due at the AGM.

I would like membership for the club as indicated below:


CategoryMembership TypeTime PeriodMembership StatusMembership Fee
ASingleHalf YearNew$25.00
BSingleFull YearExisting$35.00
CSingleFull YearNew$40.00
DJoint(2-3)Half YearExisting$30.00
EJoint(2-3)Full YearNew$45.00
FJoint(2-3)Full YearExisting$40.00








I wish to join the Escort Car Club under category         above and enclose my cheque / cash for $            .




Signed: Date