Membership Application Form

Bolton-le-Moors Car Club

Membership Application Form
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityCounty

Post Code
Email Address*
Contact Number*
Membership Required*
Name of additional joint / family membership persons (must have same address)
Family membership includes two adults and all children 17 & under. Joint membership is for any two adults who live at the same address.
Data Protection Act: In accordance with latest GDPR we will not pass on any of your personal details to a third party. For administrative purposes the information you provide will be stored on a computer database; by submitting this form you are consenting to us holding this information.*

I agree
Payment Options*

Bank TransferChequeCash
You can pay by bank transfer using sort code 09-01-50 and account number 04373782. The account name is: Bolton-le-Moors Car Club Ltd. Please use your name as a reference.

Alternatively you may send a cheque made payable to Bolton-le-Moors Car Club Ltd and post to Jack Mather, Membership Secretary, 11 Lupin Close, Whittle-le-Woods, Lancashire, PR6 7RG.

Cash can also be send via post to the membersihp secretary or handed over in person at a club night or event.

Don't forget to register for a free RS Clubman Licence with Motorsport UK!

Thank you for supporting Bolton-le-Moors Car Club.
Membership Secretary: Jack Mather

Email: blmcc.jackmather@yahoo.com Phone: 07568555242
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Bolton-le-Moors Car Club