ACR Application for Membership Form

Form

Application for CCC Membership
Classics Car Club
Application for membership Renewal and New members.

Annual subscription Rate :

(01 July 2022 to 30 June 2023) - Mainland UK £30.00

(01 July 2022 to 30 June 2023) - Mainland Europe (including Irish Republic) £44.00

Cheque made payable to Classics Car Club.

Please send your subscription to:
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityCounty

Postal / Zip Code
Enthnicity
Home Phone Number

Area CodePhone Number
Mobile Phone Number*

Area CodePhone Number
Email*
example@example.com
DOB*

DayMonthYear
Date of Birth
Vehicle Make: Manufacturer Model:Model type
Year: Year of first Registration Registration:Registration Number
Data Protection:

Data Protection and Privacy Laws require the Club to have your permission to hold your name and address on the club Database. Please read the following declaration and sign below if you agree to the conditions. I give permission to CCC to record my details as above on the club database for the sole purpose of sending me club newsletters and other related information. I will notify CCC in writing if I no longer wish my details to be kept on the database. If my details change, I should inform the club immediately. Details will automatically be removed in the event of membership not renewed.
Signature*
Please Print Name*

First NameLast Name
Date*

DayMonthYear
Date
Should be Empty:

Form