Membership Application Form

Full name:

Address:

Occupation:

Home phone:

e-mail (if applicable):

Work phone:

Make of vehicle:

Model

Year:

Colour:

Registration

Standard / Modified

Other car club memberships:

Competition license

I / we herewith make formal application to join the Mazda Rotary Enthusiasts Club (Inc) and in doing so declare, that if accepted, will abide by the constitution and rules of the Club, and enter into the spirit of the Club.

Signed:

Proposed by:

Date of application:

Seconded by:

(*husband / wife or recognised couples only). Applications will only be considered if accompanied by the appropriate subscription fee (unless by prior arrangement). This will be refunded if your application is declined. Subscriptions are only valid until the end of our financial year (31 July). Add $10 per person wishing to participate in RotorMotorSport/MANZ events

Applications are to be sent to MREC (Inc), PO Box 2404, Wellington

No.