MEMBERSHIP RENEWAL FORM - FAMILY

Member's Name [include middle name(s)]

Renewal of Membership .

Renewal Family Membership -US$250

Only complete the form for changes of address, telephone, etc.. Go to the end to pay by Credit Card

Mailbox Address if different from above

Phone No. (home) inc. code

Phone No. (mobile) inc. code

Phone No. (office) inc. code

Your E-mail Address

Partner's Full Name

Partner's E-mail Address

Phone No. (home) inc. code (if different from above)

Phone No. (mobile) inc. code (if different from above)

Phone No. (office) inc. code (if different from above)

Children up to Age 18 - Name & D.O.B.

Would you like your car stickers etc. posted

Yes, please use the above address
Please hold until I visit the office
No thanks

Comments

PAYMENT

At present, this is not an encrypted website. If you prefer, telephone your details to the Club +1 268 460 1799 (office hours)

Please tick

VISA
Mastercard

Name of Cardholder

Card Number

Expiry Date - mm/yy

Card Security Code (3 digit number on the back)

Amount of Payment (US$)

Office Use Only (Invoice/Sales Receipt No.)

Office Use Only: Database update

Office Use Only: Email Database update