Become a member TODAY!!

� RENEWAL       � NEW MEMBER       � CHANGE OF ADDRESS

Date:                                       

Mr./Mrs./Ms._____________________  ________  Mr./Mrs./Ms.                                                        

[Circle one]  [first name]            [last name]               [Circle one]    [first name]              [last name]

Address:_______________________________________________________________________   

City:______________________________________________________________ Zip:________        

Tel.:_____________________________________ E-mail:_______________________________

Memberships:         � Individual $45  � Couple $75  � Charter $25  � Widow $25

Please Make checks payable to:  British & Dominion Social Club

NO REFUNDS