P.O. Box 4265, Quesnel, BC V2J 3J3
PROSPECTOR’S MEMBERSHIP 2017

$30.00


NAME  _______________________________________________________

SPOUSE ______________________________________________________

ADDRESS _____________________________________________________

PHONE _____________________CELL _____________________________

EMAIL________________________________________________________

VEHICLE TYPE IF AVAILABLE
1st2nd3th4th
YEAR ___________ __________ __________ ___________

MAKE ___________ __________ __________ ___________

MODEL ___________ __________ __________ ___________

ORIGINAL ___________ __________ __________ ___________

MODIFIED ___________ __________ __________ ___________

UNDER
CONSTRUCTION _________ _________ __________ __________