WOMO MEMBERSHIP APPLICATION
Please forward your completed membership application to: WOMO Car Club Inc., R.R. #3, Iona Station, Ontario, N0L 1P0
REGION	___________________(see * below)
NAME	____________________________________________________________
ADDRESS	____________________________________________________________
CITY	______________________________________	PROV	__________________________
POSTAL CODE	______________________________________
PHONE	______________________________________	FAX	__________________________
EMAIL	______________________________________
NEW MEMBER    ($25 annually) RENEWAL ($25 annually) SPOUSE ($10 annually)
HOW DID YOU LEARN OF WOMO? ______________________________________________________________
HOW CAN YOU ASSIST WOMO?   ________________________________________________________________
VEHICLE INFORMATION (if you require more space, please use the reverse  of this form)
MAKE	_______________________________________	YEAR	___________________
MODEL	_______________________________________	CID/HP	___________________
COLOUR	_______________________________________	MILEAGE	___________________
CONDITION	_______________________________________
MAKE	_______________________________________	YEAR	___________________
MODEL	_______________________________________	CID/HP	___________________
CONDITION	_______________________________________
REGIONS       Region 1 - Woodstock, Stratford (Perth & Oxford counties) Region 2 - Kitchener, Waterloo, Guelph and Cambridge Region 3 London, St. Thomas (Elgin & Middlesex counties) Region 4 - Brantford, Simcoe, Tillsongburg, Delhi (Brant, Haldimand & Norfolk counties) Region 5 - Goderich, Owen Sound (Bruce, Grey, Huron & Wellington counties) Region 6 - Hamilton, Niagara Falls, St. Catherines, Welland (Hamilton-Wentworth & Niagara counties) Region 7 - Chatham, Sarnia, Windsor (Essex, Kent & Lambton counties) Region 8 - All other regions