Application For Membership Or Renewal

I hereby apply for membership/renewal of my membership of the above club,
and agree to abide by the rules and regulations of the club.

Please return to : The Treasurer, South Canterbury 4wd Club Inc., PO Box 867, Timaru 7940, together with your annual sub of $45.00 (reduced to $40.00 if paid by 20th February).

Signed : ............................................               Date : ................................

Please print the following information.

Name : .............................................               Occupation : ........................

Address : .......................................................................................................

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Contact Details :  Email ...................................................................................

Phone : Work ...........................  Home ........................  Cell ...........................

Vehicle Details : Year ..........   Make .........................  Model .............................

Vehicle registration Number:   ...........................................

Are you willing to make yourself and vehicle available to help in the event of an emergency?

Circle one             Yes       No

Equipment you have which may be of assistance, when helping dyuring an emergency, e.g. chains, methods of communication :

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