Austin Healey
Owners Association of
British Columbia
2011 MEMBERSHIP APPLICATION AND/OR DUES INVOICE
Date:
Member Name:
Address:
City: Prov./State
Country: Postal Code/ Zip:
Email Address:
Phone Numbers: Res Bus/Cell
Dues: Family Membership - $25 per year
Payment: Please enclose Cheque or Money Order Payable to: AHOABC
Or:
Provide VISA information: (outside Canada please use VISA if possible)
Name (as on card)______________________________________________________
VISA Card Number ___________________________________ Exp. ____________
***********************************************************
Require: Name Badge - Yes___ No___ New Member Kit - Yes___ No___
Please help update our records:
What Healey(s) do you presently own? (use back for additional cars and info.)
Car 1 - Yr.& Model ________________________________________
Veh. Identification Number:__________________________
Car 2 - Yr. & Model: _______________________________________
Veh. Identification Number:___________________________
Copy, complete and mail to: #602 - 1641 Lonsdale Ave ,
North Vancouver, B.C.,
Canada, V7M 2J5
or eMail completed form to: kwelch0205@telus.net
www.healeys.ca
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