ECLC - Membership Application / Renewal Form

Membership Application / Renewal

Complete the form and then either submit via email or print and send via snail mail.

Applicant/Member Information

Name:
Address:

City:
Province:
Postal Code:
Home Phone:
Work Phone:
Email:

Lotus Cars Owned Information


1:	Year	Model	Serial #	Engine #	Condition*

2:

3:

4:

5:
	* Roadworthy, In Storage, Being Restored, or a Parts Car

Newsletter / Directory Information

Do you wish your name, telephone number, email address and type number to be published in the club membership roster? Yes No

Do you wish to receive the club newsletter ONLY in electronic format via email? (valid email address req'd.) Yes No

Payment Information

Membership Dues: $10.00/year Make cheque payable to: Eastern Canada Lotus Club	Mail to:	Eastern Canada Lotus Club 1034 Hindley Street Ottawa, ON. K2B 5M1 CANADA