you will need to print this form and mail to the address shown at the bottom.
DLOC-NA MEMBERSHIP APPLICATION
Annual Dues - $35.00 USD
New Member __
Renewal __
Last Name: ________________________ First Name:__________________________
Address: __________________________ City: _______________________________
Prov/State: ________________________ Country: ____________________________
Postal/Zip Code: _______________________ Phone, Res: _________________________
Phone, Bus: ________________________ Fax: _______________________________
*e-mail: ____________________________ Spouse: ____________________________
Make of Car: _______________________ Model of Car: _______________________
Year of Car: _______________________ Serial Number: ______________________
If you have more than one car please add the information on the back of this form.
Please mail dues and form to:
DLOC-NA
C/O LINDA SIMMONDS
135 KENNER CRESCENT,
STRATFORD, ONTARIO.
CANADA. N5A 7H2
*Personal information will not be posted on the website, and will only be available to other members.