APPLICATION FOR

MEMBERSHIP

MG Car Club

(Wellington Centre) Inc.

(*) Indicates required information

*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:

 

  Phones: Home:.............
    Work:..............
*Email:............................................................... Mobile..............

Vehicles Currently Owned:

Year

Make

Model

Colour

Reg. No.

Please indicate (tick) which activities would interest you as a club member:

Trials

Driver Training

Concours

Run to Special Location

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:

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

Single:

$60

$45

$30

$60

Joint: Self plus Partner

$70

$53

$35

$70

Family:Single/Joint plus 1 or more children

$80

$60

$40

$80

Signed:

Name: (please print)…………………….....…………………………………....

Signature: Date:………………..…

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.

Office Use Only: Number Allocated:………………..D/Base Updated: Card Mailed:

Email List Updated:

Ray Hartley Motors

Ray Hartley Motors




CARBURETTOR RE-CONDITIONING

including classic &
performance makes.
Free advice.
40+ years trade
experience. Contact
Graeme Tulloch, at
Tulmac Carburettor
Specialists
on 027 612 2312 or
(Levin) 06 368 2202

Email


 

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