Membership Application – 2011

Print page, fill out form and mail to address below, or use this PDF of the membership form.

————————————————————————————–

________ New Member(s) _________ Renewal

Membership for the calendar year entitles you to participate in all club activities, Club Discount rate for the Historic Races and access to the “Members Only” portion of our club website. You also receive the AHCO Membership Roster/Directory/Constitution and By-Laws. Membership renewals are due January 1 of each year with a final deadline of February 15. Dues are $25 per individual or couple. All amounts are in US dollars. Please make checks payable to:

Austin-Healey Club of Oregon
Dennis Saxon, Membership Director
13212 SE 336 Place
Auburn, WA 98092

New Members only:

After July 1st, dues are $12.50 for the remainder of the year. After August 31st, full dues of $25.00 will cover the remainder of the current year plus all of the following year.

Member Data: All members please complete:

Name _______________________________________ Birth month: ___ Day _____
Spouse/friend ________________________________ Birth month: ___ Day _____

Street ______________________________________________________________
City _________________________ State ____ ZIP _________
Home Phone _________________________  Cell Phone _______________________

Email address ________________________________________________________
Occupation __________________________________________________________

List the Healeys you own

——————————————————————————–