Mbr_Apl

Visitors since
10/12/2008

Web Site Designed
and maintained by:
Steve Skepper


	Name:

Address:

		E-Mail:


	D.O.B (If under 18):


	Home Tel:

		Work Tel:

Mobile No:


	Membership Types

Single:   Individual membership.(Aged 21 +)
Family: Partners and children (up to age 20) residing at the same address.
            Age 21 & over, Single Membership required.
Junior: Age 12-20 Inclusive.
           Must have Junior Membership if wishing to compete.
            Junior Membership NOT required for Marshalling.

Please select type of membership required and indicate which payment method is to be used.
Membership is subject to approval by the Executive Committee.
Your membership card will be sent immediately after the next Committee meeting following receipt of application.

(Please contact the Membership Secretary if you require membership to allow you to compete at short notice and a temporary card will be issued to you.)


	Membership Type:


	Single: (£17.00)


	First Aid Experience:


	Family: (£22.00)


	Yes


	No


	Junior: (£5.00)


	What are your reasons for joining KDMC ?


	In which forms of Motor Sport are you interested in participating?


	Details of Competition car (If any).


	Do you intend to take part in the marshalling of events?


	Yes


	No


	If you have a Marshals Reg No. Enter here ->


	Previous Motorsport Associations:


	Business / Occupation:


	Declaration:


	I wish to apply for membership of Knutsford & District Motor Club Ltd.


	I agree to abide by the rules and constitution of the Club.


	Payment method:


		Cheque (Payable to Knutsford & District Motor Club Ltd.)

	PayPal (Either Own account or via Credit Card)


	Please enter the two words displayed in the panel below, as you see them. If you have difficulty in viewing the words you can request a new pair of words.


	To request a new pair of words click on the button below that looks like ->


	DATA PROTECTION ACT: Information declared above will be held on computer for KDMC Ltd. administration purposes only. This may include release to event officials.


	[Mbr_Apl]