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@gmail.com

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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