Reefton and Black Spurs Sunday May 10th, 1998

MTCV Membership Renewal Form

Please complete the tear-off below and return it with your member ship fee. Full membership fee is $25 and associate membership fee is $12.50 and is due before July 1^st. The money is used to help run the Club and pays for the printing of the magazine, itineraries, stationery, postage, supper, etc. The Club is a non-profit organisation and relies on your support for its continued existence.

Name:

Address:

Telephone Numbers: Home: __________________

Work: __________________

Mobile: __________________

Email Address:

To save Club funds, would you like your magazine sent electronically when available? yes/no

Do you have a medical condition that the Club should be aware of in the event of an accident?

……………………………………………………………………………………………………………

…………………………………………………………………………………………………………….

If there is information you wish to remain confidential, please indicate.

……………………………………………………………………………………………………………..