Golden Gate Austin Healey Club
     2010 Membership Application



Please include the following information:
      
      Date:__________________

      Name:________________________________________________
            
     Spouse: ______________________________________________

     Address: _____________________________________________

     City:  ____________________________ State:___ ZIP: ________

   
     Phone:  ____________ FAX: ___________ Cell : _____________

     Email address:  ________________________________________
    
    Healeys owned
                 Model:  _________   Serial number:___________________
                 Model:  _________   Serial number:___________________
                 Model:  _________   Serial number:___________________
                 Model:  _________   Serial number: __________________

     If you join between November 15, 2009 and May 31, 2010   $25____
     If you join between June 1, 2010 and  November 14 2010   $15____

   

               Please make your check payable to
                The Golden Gate Austin Healey Club

                We'll see you on the road!
 
                Complete this form and send it, along with your check to:
               Nick Klein, 3334 Gardendale Drive, San Jose, CA 95118