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THE GOLDEN AGE AUTOMOBILE CLUB P.O. Box 252 Truro, Nova Scotia B2N 5C1 |
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Name: ___________________________________ Please print |
Spouse's Name: ____________________________ |
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Address: __________________________________
__________________________________ Street, RR #, P.O. Box, Apt. #, etc. |
City: _____________________________________ City, Town, Village, Postal Code |
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Telephone: ________________________________ |
Occupation: ________________________________ |
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Automobiles |
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| Year | Make | Model | Condition | Cylinders |
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Condition: A-Restored B-Good Original C-Under Restoration D-Restorable E-Parts Car |
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| 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.