MEMBERSHIP APPLICATION FORM
Please Print this form and send to the address below.
BLOCK LETTERS, please
| Surname (Mr./Mrs./Ms./Miss__________________________ | Christian Names:_______________________ |
|
Address (incl. PostCode):___________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ |
| Postcode:______________________________ | Email Address:__________________________ |
| Telephone No:______________________________ | Date of Birth:__________________________ |
| Where did you hear about the club:_____________________________________________________________________________________ | |
Would you be willing to help or participate in any way in the running and organsation of the Club? YES/NO (if yes, please give details of any former experience or relevant contribution you might Consider useful.
DETAILS OF VEHICLE/S FOR REGISTER
| Model of Vehicle/s owned:.......................................... | Colour: .................................................................. |
| Year of Manufacture: .................................................. | Registration Mark:................................................... |
| Engine No: ................................................................. | Chassis No:............................................................ |
Please list on reverse of this form full details of any special points of interest (e.g., modifications, alterations, prizes, etc.). State whether modifications carried out by yourself. I would like to be elected a Member of the "Ford Anglia 1O5E Cwners' Club Ltd". I hereby agree to abide by the Rules of the Club and Bye-Laws of the Club and by all current amended and substituted Rules, and Bye-Laws.
Please note that due to insurance stipulations we are
no longer able to supply parts to members living or residing in U.S.A. or
Canada.
Applicants are advised that their membership details will be held on computer.The list is confidential and used only for providing address labels for club communications and lists of members fo internal use only.
Subscription runs from the 1st January to 31st December
| Signed.................................................... | Dated........................................................ |
I enclose herewith - Cheque/Postal Order No.:...............................................payable to "Ford Anglia 105E Owners' Club Ltd"
Your Membership Card (when issued) will be your form of receipt.
After completing this form please send it together with your Subscription, Registration Fee
| 2008 SUBSCRIPTION RATES | JOINING FEE | ANNUAL SUBS | TOTAL |
| UK | £3.00 | £26.00 | £29.00 |
| EUROPE | £3.00 | £28.00 | £32.00 |
| REST OF WORLD | £3.00 | £30.00 | £33.00 |
To: THE MEMBERSHIP SECRETARIES: Nigel & Stella Scott, 30 Langwith Road, Bolsover, Derbyshire, S44 6HQ