Buick Car Club Membership

Name:	_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Partner's Name:	_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Address & Postcode:	_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Email Address:	_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Telephone:	_ _ _ _ _ _ _ _ _ _ _ _ _ _	BH	_ _ _ _ _ _ _ _ _ _	AH:
	Mark this box if you do NOT wish your details published in Buick Car Club directories.

FEES & PAYMENT OPTIONS:

Annual Subscription
(includes monthly Journal)

A$50.00 Australia (A$60.00 Overseas)
Junior Member (Under 18) A$25& No Joining Fee. Joining Fee for new members A$10.00

I enclose:

Cash

Cheque

Money order

Debit my Credit Card:

Visa

Mastercard

Bankcard

Cardholder's Name:	_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _	Amount: $	_ _ _ _ _
Card Number:	_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _	Expiry:	_ _ /_ _
Cardholder's Signature	_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Member's Signature:	_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
	Next line for New membership only:
Nominating Member:	_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Please forward to:

The Secretary
Buick Car Club of Australia Inc.
PO Box 320
Sunbury, Vic 3429

Condition:
OR - Original Running
RES - Restored
TBR - To be restored
PC - Parts car
UR - Under restoration