APPLICATION FOR MEMBERSHIP (Please
print and complete by hand in BLOCK CAPITALS) |
To: Myrtle Stevenson, 2 Lorton Cottages, Lorton Lane,
Broadwey, Weymouth, DT3
5QH
I hereby apply for membership of WOOLBRIDGE MOTOR CLUB Ltd., and undertake to comply with
the Rules and Regulations. |
| Surname (Mr/Mrs/Miss/Ms) |
| Christian Name(s) |
| Wife or Family Members, Christian Names
if applying for membership: |
Address
Post Code |
| Tel No:
(Home).....................................................................
(Work).................................................................. |
| E-mail
(Home).......................................................................
(Work).................................................................. |
| Main Motorsport interests |
| Full Membership |
£15.00 |
(Please tick any extras below) |
| Member's wife or other family members |
£2.50 |
|
| Plastic 10" x 2" club sticker (external) |
£0.35 |
|
| Plastic 10" x 2" club sticker (internal) |
£0.35 |
|
| Plastic 4" round club sticker (internal) |
£0.35 |
|
Total |
|
|
|
| SIGNATURE OF APPLICANT ............................................DATE....................... |
Please sign the Banker's Order below which will be
implemented after election. |
| The Manager.......................................................................................................................................Bank
Plc |
| Bank Address Post Code..............................................
|
| For the credit of Woolbridge Motor Club Ltd., National
Westminster Bank Plc., 49 South Street, Dorchester, Dorset. (Sort Code 60-07-01 Account
No. 58595376) |
The sum of £...................
(figs).................................................................(words) forthwith
and thereafter
The sum of £....................(figs).................................................................(words)
on the first day of October each year until further notice. Any previous order to make
payment to the payee is hereby cancelled. |
| SIGNED..................................................................................DATED..................... |
| Name (BLOCK CAPITALS) |
| Address Post Code........................................... |
| Bank Account No. |
