Renewal_Form

Visitors since
10/12/2008

Web Site Designed
and maintained by:
Steve Skepper

Association of Northern Car Clubs

Welsh Association of Motor Clubs

East Midlands Association of Motor Clubs


	Name:


	Address:


	Home Tel:

	Work Tel:

	Mobile Tel:


	E-Mail:


	Marshal Reg No:


	I wish to apply for


Membership Type:


	Single (£17.00)


	Family (£22.00)


	Junior (£5.00)


	Family Membership


	If you require membership card for other members of your family, please complete the following fields:


	Other Name:


	D.O.B. (If under 18)


	Please enter below any changes since your initial application. e.g. Occupation, Motorsport Interests, Motorsport Qualifications, How you would like to get involved etc.


	Changes:


	Payment Method:


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


	PayPal (Either with your own account or by Credit Card)


	Now enter the two words displayed in the panel below as you see them. If you have difficulty in reading the words, you may request a new pair of words


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


	Now, Click on ‘Submit’ below to send your application or ‘Reset’ to clear all the fields






	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_Rnw]