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Membership -  1st June 2011 to 31st May 2012

                     

 

 

 


If you wish to join or renew your Membership please fill out the form, attach payment and post to:

ESCC Membership,

PO Box 216,

Gore 9740

Name (s) _____________________________
Address
______________________________ 
__________________________________
__________________________________

Phone
_______________________________
E-mail
_______________________________

(please fill in your e-mail address as this is how our news is sent out)


Age group (under 18) * (18-25) * ( 26-35) *  (36-60) *  (61+)
(Please circle one )


Single Membership $50-00
Couple Membership $55-00
Junior Membership $25-00


Total $ __________________


(Junior members must be under 18 years old on 1st June 2011 and require an under age
indemnity signed by a parent or guardian to Compete in events.)

 

Send mail to ejem@southnet.co.nz

Copyright ©  Eastern Southland Car Club

Site Last Updated 29/08/2011

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