Manitoba Driving Society

Application for Membership

Name(s):

 

 
Address:

Phone:
City: Province: Postal Code:
E-mail:

Driving division that most interests you (please check off):

Recreational        Combined         Pleasure

Cost:       $25 Individual        $50 Family            $10 Associate

Age Bracket (check off which ever of the following that applies):

A) 12 & Under      B) 13 to 17        C) 18 to 29       D) 30 to 40      E) 41 to 54        F) 55 plus

Applicant Signature                                                          Date:

Guardian Signature

Manitoba Driving Society Membership

Contact Information:

Irene Malone
Box 10 Group 2 R.R. #2,
Dugald, MB
R0E 0K0
Phone: (204) 444-4652
E-mail: irenem1@mts.net