West Michigan
              "Old Speckled Hen" MG Car Club
                   Membership Application

                       New or Renewal


We welcome your participation and membership. Simply
print this form, fill it out and return with your
payment (Checks please if mailed) to:

Tim Sterken
O.S.H. Membership Chairman
2382 East Beltline NE
Grand Rapids, MI 49525
(616) 364-8538

Dues: $20.00 per year (April 1 - March 31)
      $10.00 per half year (October 1 - March 31
      

Name(s)______________________________________________________________

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Address______________________________________________________________

City_________________________________________________________________

State/Zip____________________________________________________________
       
Phone (   )__________________________________________________________

E-mail_______________________________________________________________

MG(s) owned (model/year)_____________________________________________

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Special talent you can share with the club?__________________________

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