Victoria MG Club ... Membership Application Form

Please type the required information into the appropriate fields and 'print' the form using your computer.

Annual Dues: $25.00 in Canadian Funds

Contact information:

First Name:
Last Name:
Spouse or Partner's Name:
Street Address (Line 1):
Street Address (Line 2):
City:
Province / State:
Postal Code / Zip:
Country:
Home Phone:
Cell or Work Phone:
E-Mail Address (1):  
E-Mail Address (2):
 
Vehicle(s) used to attend Club Events:

Membership Date: __________________________

I hereby consent □ do not consent □ (check appropriate box) to my personal information (as above) apprearing on the membership list that is given out to the members of the Victoria MG Club. By completing and returning this membership registration form and providing your signature (below), you are consenting to the collection of personal information for inclusion in the membership distribution list.

________________________________________ Signature

 

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