AMOA - Membership Form 2010

Street Address

Address Line 2

Car	Year	Make	Model	Body Style	Special Features
1
2
3

Dues Member *: $35/year OR # of months @ $3/month = $.00
Associate: # of person(s) @ $5 each = $.00

TOTAL: $.00
* New members - Enter the number of months to next April 1 (Membership period is April 1 to March 31)

Liability Release In consideration of the acceptance of my application to join the Alberta Mustang Owners Association, I, my family, and my guests, by execution of this release form, release and hold harmless The Alberta Mustang Owners Association and anyone else connected with the organization, management, or presentation of any Alberta Mustang Owners Association meetings, tours or events, of and from any losses, judgments, and/or claims from any cause whatsoever that may be suffered by me, my family, my guests, to person or property.

I have read and agree to all conditions of this release form and agree to observe all rules and decisions of the Alberta Mustang Owners Association made by organizers or management.
Member Name Signature Application Date

OFFICE USE ONLY - PLEASE DO NOT FILL OUT Received by: _______________________________ Membership Year: 20___ - 20___
Amount Paid: $_______.⁰⁰
Date Paid: __________________
Membership Number: ________________________
Card Issued: _______________________________
Member Since: _____________________________
Receipt issued: _____________________________

PLEASE ALLOW 1-5 WEEKS FOR PROCESSING