American Bantam / Austin American Bantam

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 ($20/yr):

International ($25/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: