GRAHAM OWNERS CLUB
INTERNATIONAL INC.
MEMBERSHIP APPLICATION
Please print
out the following form and mail it to :
PH 510-886-7599 fax 510-733-5081
PLEASE PRINT CLEARLY! DATE:_______________
NAME:__________________________,First_______________(Spouse)___________________
ADDRESS:_______________________________________________________________________
CITY:__________________________ STATE/PROVINCE:________________________________
COUNTRY:_________________________________ZIP OR POSTAL CODE:___________________
PHONE:( )-______ - ______________(OPTIONAL) FAX____________________
EMAIL ADDRESS ______________________
Do you own a Graham/Graham related vehicle? YES______ NO______
VEHICLE OWNED; (CHECK ALL THAT APPLY)
GRAHAM-PAIGE:______ GRAHAM:______ PAIGE:______ GRAHAM BROTHERS:______
JEWETT:______ PAIGE-COMMERCIAL:______ HUPP-SKYLARK:______
BRADLEY:______FRAZER(GP):______ ROTOTILLER:______ MODIFIED: ______________
YEAR:______ Model No:.______ Model name:______ Color: ________
Body style:__________ Serial No:________________ ENG. No:_________________
Name of Previous Vehicle Owner (Club Member?)_______________________________
Would you consider being a Technical advisor on this model? YES:____ NO____
TYPE OF MEMBERSHIP (circle one)
USA.........................$23.00 PER YEAR
CANADIAN & OVERSEAS.........$27.00 PER YEAR...US FUNDS ONLY
NOTE: Prorating of dues is for New Members Only
When joining mid year, partial annual dues may be paid with a payment of next years dues;
ie, joining Sept 1 thru Nov 30 pay 1/2 plus next year's dues = ( $34.50 USA, $40.50 others),
Dec. 1 thru Mar. 1, pay 1/4 plus next year's dues = ($28.75 USA, $33.25 other).!
You may pay dues up to three (3) years in advance, which is available to all members.
Dues must be payable In US FUNDS ONLY !!!
You may pay your dues by check, postal money order or credit card. If you choose to pay
by postal money order or check please mail the payment along with a printout of this
application to the Treasurer's address above.
If you choose to pay by credit card please
add an additional $5.00 processing fee to the above amounts.
Please have your credit card ready.
You will also need the
The Card Security Code (CSC) is a 3- or 4-digit number
printed in the signature field on the back of your credit card. On some cards,
the credit card number, or part of it, appears before the CSC. The number
appears only on the card itself (not on your receipts or statements).
Enter the total amount in the box below (Don't forget to add the $5.00 processing fee)
When you are ready to pay, click the button below. That will take you to a secure site to process the credit card
payment. In addition, please print this form and mail it to the treasurer's address so the above information gets
added into the roster.
How did you hear about the GOCI?__________________________________________________
Are you a previous GOCI member, renewing membership?______________________________
Any Questions or Comments?________________________________________________________
