Please fill out, sign and fax/email to Eric Mallard

First Name :
Surname :
Postal Address :


Post Code:
Email Address:
Telephone: Home :
Work :
Mobile :
Fax :
I hereby apply for membership of the Formula Ford – New Zealand Inc.
I agree to observe and comply with the constitution and bylaws of the Formula Ford/F1600 Association of New Zealand Inc.
I authorise the Association to maintain and use my personal information for all purposes in connection with my membership.
I acknowledge that my rights to obtain access to and have corrected all of my personal information which is held by the Association.
Signature :
Date :
Membership Fees :
$140.00 per annum
$130.00 per annum for non-drivers