Printable Membership Application

Use the print feature of your browser, fill in, and sign the form, and mail to:

P.O. Box 33342
Jeppestown
2043

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Type of Membership

9 New Member

9 Renewal

Name:

___________________________

Spouse/Partner Name:

___________________________

Address:
___________________________

___________________________

___________________________

Town, Province:
_____________ , _____________

Phone:

Home:(____)_______________

Work:(____)_______________

Cell:______________________

E-mail:

___________________________

Where did you first hear about the Austin-Healey Club SA?
_______________________________________________

_______________________________________________

Healey(s) you currently own (Mark with :)

9 BN1 100 (3-speed transmission)

9 BN2 100 (4-speed transmission)

9 BN4 4-seat 100-6
9 BN6 2-seat 100-6

9 BT7-I 4-seat 3000 MkI
9 BN7-I 2-seat 3000 MkI
9 BT7-II 4-seat tri-carb 3000 MkII

9 BN7-II 2-seat tri-carb 3000 MkII
9 BJ7 3000 MkII (roll-up windows)
9 BJ8 3000 MkIII
9 AN5 "Frogeye" Sprite

9 AN6 Sprite MkII 948cc engine

9 AN7 Sprite MkII 1098cc engine
9 AN8 Sprite MkIII
9 AN9 Sprite MkIV
9 Other Healey _________________

Car Number/VIN
(example: BN2K13579 or HBJ8K34567)

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Type of Payment (Present subscription is R150 per anim.)

9 Cheque

9 Cash