Dues are $30 for
Individual membership and $50 for Family membership.
Calendar Year 2009
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#
_________
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 ______