PIEDMONT BRITISH MOTOR CLUB

(FOUNDED JUNE 1994)

Membership Application/Renewal Form

 

 

Our Club is dedicated to the maintenance, preservation, and family enjoyment of English Motor Vehicles.  Ownership of English motor vehicles is not necessary.

 

MEMBERSHIP FEE for NEW MEMBERS IS $15.00.  New members who join between March and May will have membership annual renewal dues paid through May of the following year.

 

Dues are due in June of each year.  The annual renewal fee for dues is $25.00.  There is a $10.00 discount for dues paid prior to May 31st of each year.

 

Owner’s name: ____________________________ Spouse’s Name ___________________________

 

Owner’s Birthday: (D/M)____________________  Spouse’s  Birthday: (D/M)___________________

 

Anniversary: ________________________

 

Address: ___________________________________ City: ______________________ State: ______

 

Zip: _________ Home Phone: ____________________ Other Phone: _________________________

 

E-Mail Address: __________________________________________________________

 

Interest:    □ Driving Tours        □ Rallyes          □ Tech. Sessions          □  Other: ____________________________  

 

Special talents/expertise that you would be willing to share:  __________________________________________________

 

                                                                                

                                                                                              BRITISH MOTOR VEHICLES CURRENTLY OWNED

 

               

  Model Year Condition Chassis or Commission Number
1.        
2.        
3.        
4.        
5.        

 

 Text Box: Club Use Only
Date Received: __________________     Amount Received: _____________________     Member #: ____________
Check # ____________                            Dues Paid ________________________  thru  _______________________

 

 

 

Make Checks payable to: “PBMC”.       Mail to: PBMC      663 Kenway Loop      Mooresville NC 28117

(Rev January 2008)