USA/ CANADA New Member Application USA/ CANADA New Member Application Subscriptions are due on 1st January Subscription Rate for US and Canadian Members is $45. Payment can be paid: 1. By Stripe payments system using a credit debit card 2. By Bank transfer or by standing order Allard Owners Club Account No 00672348 Sort Code 30 98 74 Please select your relevant regional representative from the drop down box lower down in the form to ensure it is submitted to the correct person. Members in the United States /Canada can pay directly to: Regional Co-ordinator USA & Canada – Andy Picariello P.O. Box 1378 Marston Mills, Massachusetts 02648 USA. Tel 001 508 420 2914 Fax (001) 508 420 2666, or email: Andy Picariello Title Please choose an option Mr Mrs Ms Dr Prof Lord Lady Sir First Name Last Name Car – Make Car – Model Car – Chassis No Car Registration Number Phone Email Address Address Address Address City City State Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State Zip/Postal Zip/Postal USA/ CANADA Regional Representative Membership Fee – USA Credit Card We agree to abide by the rules and regulations of The Allard Owners Club Member’s Signature Clear Date If you do not want your details to appear in the Year Book please tick the box Membership details are held by the club as part of their database. No information about a member will be disclosed without permission Apply & Pay Now If you are human, leave this field blank.