Austin Bantam Society Membership Application
Bold
fields are required. Upon submitting this form you will be directed to a secure payment area.
Name:
Address:
Phone:
E-Mail:
Membership Type
USA ($25/yr):
International ($30/yr):
Renewal:
(adds $1 to membership fee)
Payment
Credit Card:
Optional Information
Spouse's Name:
Austin(s) and/or Bantam(s) or Other Club Cars presently owned
Year:
Body Style:
Body Number:
Engine Number:
Frame Number:
Condition:
Car 2
Year:
Body Style:
Body Number:
Engine Number:
Frame Number:
Condition:
Please enclose photo(s) of your car(s) for possible use in Rooster Tails
Photo 1:
Photo 2:
Photo 3:
Comments:
