Blue Ridge Land Rover Club

Membership Application/Renewal Form

 

Dues are $30 for Individual membership and $50 for Family membership.
Calendar Year 2011

To apply or renew, print this page and fill in the blanks.

(Do not send cash.)
Make check payable to BRLRC and mail to:

 

BRLRC Membership Coordinator
Cyndy Boggs
2397 White Mountain Rd
Afton, VA  22920

 

Please Print (This information is important. we need to be able to read your mailing and email address )

Please Supply the following information:    New Application: ____    Renewal: ____ 

Type of Membership requested:    Individual $30 _____    Family $50 _____

Name:__________________________________________  BRLRC# _________  if renewing.

Address:___________________________________________________________________

City:___________________________________     State:______      Zip:____________

Home Phone:_____________________  Work Phone:__________________________

e-mail:_______________________________________________________________

(Important for event notification – print clearly)

Number of Land Rovers you own:_____________ (or jointly owned/running or not)

Rover #1 Type __________________ Color:_____________  Year  ______

Rover #2 Type __________________ Color:_____________  Year  ______

Rover #3 Type __________________ Color:_____________  Year  ______

Rover #4 Type __________________ Color:_____________  Year  ______

 

Print the above form and fill it out.
Mail along with you check made out to  BRLRC to the address at the head of the form