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





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




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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