Nova Scotia Driving Society

2012 Membership Application
Please complete and send to:

Nova Scotia Driving Society

c/o Hazel Brenton
69 Princeport Rd.,
Princeport, N. S.
B6L 1R2
Tel. 895-8908  E-mail hazelbrenton@gmail.com

2012  Membership fees: Individual Membership - $10.00
Family - (parents and all children under 18) - $15.00

Cheques are to be made payable to the Nova Scotia Driving Society

Name:_______________________________________________________

Address: Street or civic #________________________________________

                RR# or P. O. Box#______________________________________

Village/Town/City:______________________________________

Postal Code:___________________________________________

Telephone:_______________________E-mail_______________________

Interested in: pleasure driving______showing______driving clinics_______

cross country/marathon______obstacle______recreation_____other______

For Family Members only:

Spouse’s name________________________________

Names of children under 18 as of January 1st 2012
________________________________________________________________________