THE GOLDEN AGE AUTOMOBILE CLUB
Membership Application

P.O. Box 252

Truro, Nova Scotia

B2N 5C1

 

Name:  ___________________________________

Please print

 Spouse's Name: ____________________________

 

Address: __________________________________

 

               __________________________________

Street, RR #, P.O. Box, Apt. #, etc.

 

City: _____________________________________

City, Town, Village, Postal Code
 

Telephone: ________________________________

  

Occupation: ________________________________

 

Automobiles
Year Make Model Condition Cylinders
 

 

        
 

 

        
 

 

        

Condition: A-Restored  B-Good Original  C-Under Restoration D-Restorable E-Parts Car

 

Date: ________________________ Signature: __________________________________________

Membership Dues are $20.00 per year and shall be paid in November of each year. 
New memberships received after September 1, and before November 31 will be extended to the next fiscal year.
Please make cheque or money order payable to "The Golden Age Auto Club" or submit CASH to the Treasurer.