APPLICATION FOR MEMBERSHIP

IN THE

ZODIAC & ZEPHYR CLUB SOUTHLAND INC.

DATE

NAME

SPOUSE/PARTNERS NAME

ADDRESS

CHILDREN (12 & UNDER) 

PHONE(s)

E-MAIL

MAKE OF CAR

 MODEL OF CAR

YEAR OF CAR

SIGNED:

SIGNATURE OF SENIOR EXECUTIVE MEMBER

Print this form and complete - then forward to

Mike Gutsell – Membership Coordinator

E-Mail  Mike  for membership information