APPLICATION FORMEMBERSHIP |
MG Car Club (Wellington Centre) Inc. |
(*) Indicates required information
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*Applicant: Full Name:
*Age Range (Please circle) Partner/Spouse: Age Range (Please circle) |
.......................................... Under 18 18-25 26-35 36-60 over 60 ......................................... Under 18 18-25 26-35 36-60 over 60 ...................................... |
................................ Children under 18: ................................ .............................. ............................... |
*Address: |
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| Home:
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| Work:
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| *Email:
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Mobile:
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Vehicles Currently Owned:
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Year |
Make |
Model |
Colour |
Reg. No. |
Please indicate (tick) which activities would interest you as a club member:
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Trials |
Driver Training |
Concours |
Run to Special Location |
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Club Night Dinner |
Noggin N Natter |
Brunch/Lunch Run |
Other: |
Do you have, or intend to have a Race Licence:
Subscription Please circle the appropriate subscription:
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Full Year: (July-Sept) |
Oct-Dec |
Jan-Mar |
Apr-Jun(includes following year |
Please post this form with a cheque to: The Secretary MG Car Club P O Box 3135 Wellington 6140 Alternatively you may pay by direct credit to 03 0539 0165992 00. Please place your name and 'New Subscription' in the Reference fields. You must still post or email the scanned form to secretary@mgcarclub.org.nz |
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Single: |
$70 |
$53 |
$35 |
$70 |
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Joint: Self plus Partner |
$80 |
$65 |
$40 |
$80 |
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Family:Single/Joint plus 1 or more children |
$90 |
$68 |
$45 |
$90 |
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Signed: Name: (please print)…………………….....………………………………….... Signature: Date:………………..… |
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Privacy Act 1993:
The personal information above is collected and will be used by the MG Car Club (Wellington) Inc. for the purpose of the advancement of the sport of motoring. You have the right of access to, and correction of, personal information about you that we hold. By signing above, you give the club permission to publish your name, address phone number & Email address in activities directly related to the club.
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Office Use Only: Number Allocated:………………..D/Base Updated: Card Mailed: Email List Updated: |
