Surname:…………………………… Given Name: ……………………………….

Family Members joining…………………………………………………………………………………………………….

Mailing address: ………………………………………………………………………………

E/mail address: ..........................................................……………………………………...

Age (if junior,<18), otherwise, occupation: ……………………….

Membership Number:….……if you have a preferred number between 20 and 999, please include, these numbers will be issued on a first come first serve basis)

Membership Type (see below) and year of first AHSDC Membership: …….…..….?…/…?….………..….

Phone (AH) (BH)

Sprites Owned (max. of 3): (Model / Make / Chassis No./Reg No./colour / Engine number and capacity)

eg. Mk1 Sprite/YHAN5-6000 /ABC567 / Red / 9CUH104678, 948cc

Car 1…………………………

Car 2: ……………………………

Car 3: ……………………………..

Club Activities – You currently favour (unknown) type club activities. If otherwise, please rank in order of interest

Competition ................ Concourse/Restoration ................ Social Events .............

After completing the above details could you please sign this form and return it and your remittance to:

The Membership Secretary AHSDC

173 Progress Road

ELTHAM NORTH VIC 3095

Membership Types and Subscription rates for the 2006 year are (please circle your membership type):

Note: - Payments may also be made by Internet Transfer directly to the club’s Bank of Melbourne account

The account details are: BSB 033 337, Account Number: 129572

Please quote "«Surname» Membership" in the description box so that we can identify your payment. We will not be held responsible for transfers to wrong account numbers, This form still needs to be returned.

5. Associate membership is allocated to those members who do not own Spridgets (same subscription rate).
6. Non financial members at the end of February 2006 will be deleted from the mailing and membership list.

I hereby apply for membership renewal of the Austin Healey Sprite Drivers Club Inc. and attach cheque/payment for

$ .............., being subscription for the year ending 31 December 2006. If accepted I agree to abide by the Rules and Constitution of the Club.

Signed -------------------------/Family Members------------------------------------------Date / /200