Joint Membership Application Form

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Joint Membership Application Form Powered By Docstoc
					Maple Leaf Rally Club
           2008 Membership Application Form

Principal Member                                                                                                                     Please fill all green boxes
First name                                   Last name                                                 MLRC #         Life (Y/N)    DOB

Address                                                                                                Apt #:

City                                                                      Province                                    Postal Code
                                                                           / State                                     / Zip
Home                                                       Business                                                   Mobile

Email                                                                                                  HAM Radio
                                                                                                       Call Sign

Joint Member
First name                                   Last name                                                 MLRC #         Life: (Y/N)   DOB

Address                                                                                                Apt #:

City                                                                      Province                                    Postal Code
                                                                           / State                                     / Zip
Home                                                       Business                                                   Mobile

Email                                                                                                  HAM Radio
                                                                                                       Call Sign

Information
Performance Competitors (Y/N)                                             MLRC Volunteer Work (Y/N)



Payment         First Member = $70, joint members $30 extra each (to maximum of 4, please attach second page for joint member information)
Name on Credit Card

Card Number                                                            Expire                                     CID
                                                                       (mm/yy)
                       *** Please attach second page if address above is not the same as the address on file with credit card company. ***
                (CID: VISA/MC, last 3 numbers printed on the back, AMEX, 4 numbers printed above last 5 of the credit card number on the front.)
Cheque (Y/N)                                 Cash (Y/N)                                  Please make all cheques payable to: Maple Leaf Rally Club



Send to
    Address: PO Box 727, Downsview, Ontario M3M 3A9, Canada                          Fax: 1.905.471.9919                     Email: membership@mlrc.ca


A Membership card will be sent out after the application has been processed, and CARS (Canadian Association of Rallysport) will be notified that you are a
member in good standing. For any inquires, please contact the membership chairman: membership@mlrc.ca or visit out website: www.mlrc.ca US members to
remit in US funds. Mailings will be sent to the first address only. A National affiliation fee is included in the amounts shown. Life Members must remit the $15.00
affiliation fee to be Active.

Signature                                                                                                             Date




             6a9a09b9-0275-4f55-b07c-d9613b645a6b.xls                                                                                                 1 of 2
Maple Leaf Rally Club
           2008 Membership Application Form

Joint Member 3                                                                                Please print all information below
First name                              Last name                            MLRC #      Life (Y/N)    DOB

Address                                                                      Apt #:

City                                                              Province               Postal Code
                                                                   / State                / Zip
Home                                                 Business                            Mobile

Email                                                                        HAM Radio
                                                                             Call Sign

Joint Member 4
First name                              Last name                            MLRC #      Life: (Y/N)   DOB

Address                                                                      Apt #:

City                                                              Province               Postal Code
                                                                   / State                / Zip
Home                                                 Business                            Mobile

Email                                                                        HAM Radio
                                                                             Call Sign

Credit card information if different from principle member home address
Company Name

Address                                                                      Apt #:

City                                                              Province               Postal Code
                                                                   / State                / Zip
Telephone number




             6a9a09b9-0275-4f55-b07c-d9613b645a6b.xls                                                              2 of 2

				
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