Membership Form

Posted by on Jan 10, 2018 in Membership form and rally entry | 0 comments

Kinsale Vintage & Classic Motor Club

Hon. Secretary: Ann O’Regan, Tuosist House, Knockleigh, Belgooly, Co. Cork. P17 CR98

TEL. 00 353 (0)87 6822853 annsl350@eircom.net

www.kinsalevintageclub.com

 

 

MEMBERSHIP FORM

 

Application for New or Renewal of Membership. Please complete fully to upgrade club records.

 

BLOCK CAPITALS PLEASE.

 

Name: ______________________________     Address: ________________________________

 

 

 

 

Home Phone Number: ____________________      Mobile Number___________________________

 

Email Address: ___________________________   Occupation: ______________________________

 

Other Motor Club of which you are a member: ____________________________________________

 

Motor clubs of which you were previously member ________________________________________

 

Were you ever refused membership of a Club? ____________________________________________

 

Cars in possession: __________________________________________________________________

 

Make: __________________________________________________________________________

 

Model: ___________________________________________________________________________

 

Year of Manufacture: ________________________________________________________________

 

Condition: ________________________________________________________________________

 

Date of last Engineer’s report: _________________________________________________________

 

Are cars currently insured? ___________________________________________________________

 

If Yes, Name the Insurance Company: __________________________________________________

 

I declare that my vehicle will be fully insured (Under the Road Traffic Act 1961) For All Club Events.

 

I agree to abide by the rules and bye-laws of the Club.

 

Signed:___________________________________    Date:  _________________________________

 

Proposed by: _________________(Club Member)     Seconded by: _______________ (Club Captain)

 

SUBSCRIPTION:  €35.00  single  €50.00 Per couple or family. Per year.

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