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MODEL
OF BOLWELL(s):
mk 1V
mk V
mk V1
mkV11
Nagari
Ikara
VEHICLE
ORIGIN:
Coupe
Sports
Factory
Fibrecar
Replica
Registration
No:
Serial or Chassis No:
Colour:
SPECIFICATIONS:
Chassis type:
Engine:
Gearbox:
Differential:
Brakes:
Wheels:
Other details:
CONDITION:
Going
Static
Minor repairs
Major repairs
OTHER
VEHICLES IN YOUR GARAGE:
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VICTORIA
MEMBERSHIP ONLY
TYPE
OF MEMBERSHIP:
Full
year subscription (from 30th June each year) - $50.00
Second Half of year subscription - $30.00
Interstate membership - $35.00
Mould share - $200.00
Interested in
recieving Slipstream by email Y/N
New
members only -
Introducted to BCCA(VIC) by________________________
Your cheques
should be made out to The Bolwell Car Club of Victoria Inc.:
Your
membership will be activated once your payment has
been received. The postal address is:
THE SECRETARY BOLWELL CAR CLUB OF AUSTRALIA(VIC) INC.
PO Box 1009
RINGWOOD Vic. 3134
AUSTRALIA
| Office
use only: |
|
| Date
Joined: |
Membership
No: |
| Amount
Paid: |
Receipt
No: |
| Period: |
Share
No: (If purchased): |
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to map
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