INTERNATIONAL MIRROR CLASS ASSOCIATION OF NSW INC.

Membership Application 2008 - 2009

_________________________________________________________________________________

First Name
Last Name
Street Address
Suburb/Town
State
Postal Code
Work Phone
Home Phone
Mobile
E-mail

    Fee Structure

 Family     $30.00

 Additional boats [ea]     $10.00

Boat & Club Information

  Boat Name:         

  Sail Number:      

  Club:                    

  Additional Boat 1:  

  Additional Boat 2 : 

Please make your cheque payable to "IMCA of NSW [Inc]"

Mailing Address: Mirrors NSW, P O Box 572, Roseville, NSW 2069

[or join at any Association event]

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