Registration

K-W & Area Bug Club
2020 Membership Application Form

 

Your First Name (required)
Your Last Name (required)

Your Address (required)
Your Town/City (required)
Your Province

Your Postal Code (required)
Your Phone Number (required)
Your Email Address (required)

Tell us about your VW's;
First Vehicle Description (year, make, model, colour, special notes, etc.)

Second Vehicle Description (year, make, model, colour, special notes, etc.)

Third Vehicle Description (year, make, model, colour, special notes, etc.)

I hereby give the K-W & Area Bug Club permission to use my email address for the purposes of club communications. (required)
I agree

I hereby give the K-W & Area Bug Club permission to share the following information with
other K-W & Area Bug Club members (check all that apply) - optional):

Email Address
Phone Number
Postal Address

Individual/family membership dues are $10/year. How would you like to pay?
E-TransferMail a ChequeCash/Cheque (to a member of the K-W & Area Bug Club executive)

We will immediately send you an email response with contact info for E-Transfer and Mail in details.

Note - If you do not receive an email shortly after submitting this form, please check your junk-email folder and add us to your trusted senders list.

The completion and submission of this electronic form constitutes your digital signature.

Upon receipt of payment, you will be enrolled in the club!