Austin Bantam Society Membership Application

Membership: $25.00 per calendar year; Outside U.S. $30.00 (airmail) 

                        (Ownership of an Austin/Bantam etc. is not a prerequisite)

Name _______________________________________________Spouse’s Name __________________

Address ___________________________________ Phone and/or E-mail ________________________

City _____________________________ State ____  Country __________________Zip ____________

Please make your check payable to AUSTIN BANTAM SOCIETY and return with this form to:

                                    Membership Chairman

                                    Austin Bantam Society

                                    1036 Creek Crossing

                                    Coppell, TX 75019

         Austin(s) and/or Bantam(s) OR Other Club Cars presently owned

Year    Body Style      Body Number      Engine Number      Frame Number if any        Condition

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(When available, please enclose photo(s) of your car(s) for possible use in Rooster Tails)

Remarks of particular interest regarding ABS or the cars. ____________________________________

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