Marty Van Scoyk, President
8334 W. Nevada Place
Lakewood, CO 80226
303-989-2523

Instructions: Fill out and print this form. Mail it no later than February 15, 2007, along with your payment, to:  
Jan Van Scoyk
8334 W. Nevada Place
Lakewood, CO 80226
303-989-2523

Name:  

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                (last)                                            (first)

Spouse:

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Address:

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City:

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State: _____  Zip:  _________

 

 

 

Home Phone:

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Email Address:

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Austin Healey(s) Presently Owned:

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Serial Numbers/Color:

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New Membership:  Renewal:

 

RMHC Membership

$20.00

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total Enclosed:

$_______

 

 

 

 

Check Number:

 ________

 

 

 

Make check out to RMAHC AND MAIL TO:

Jan Van Scoyk
8334 W.
Nevada Place
Lakewood, CO 80226
                   

NOTE !!

We are no longer handling the collection of the other clubs dues. Please send your payment directly to them. Thanks !