TARLTON MOTORSPORT CLUB
MEMBERSHIP FORM
Tel: (011) 762-5431 / Fax: 762-5474
SURNAME:					FIRST NAMES:
Physical Address:
									Code:
Postal Address:
									Code:
Tel:(H)/(W):				Fax:				Cell:
MEMBERSHIP OPTIONS (12 months from start date):
(Please tick appropriate box):
				1.  R350.00 (Member plus 1)
					Provides free entry to each Tarlton race event listed on the reverse
					for the relevant member plus one other person.
				2.  R600.00 (Member plus 3)
					Provides free entry to each Tarlton race event listed on the reverse
					for the relevant member plus three other people.
		Please fax the signed copy of this membership form together with the deposit slip to the
		fax number shown above.
		Due to the unreliability of the post office, we cannot post membership cards.  These may be
		collected from the entry office located at the second gate at the next meeting.
BANKING DETAILS:
Bank:		First National Bank			Branch:	Krugersdorp
Branch Code:		250241			A/C No.:	5124/2077/795
	Signed								Date