Two Peaks Motor Club Membership Application

Please choose your choice of membership subscription*

Single SubscriptionFamily Subscription (2 people)

Main Applicant

Members Name*

First NameSurname

Address*

Street Address

Street Address Line 2

Village/Town/CityCounty

Post CodeCountry

E-mail Address*

Confirmation EmailThis will be used for all correspondence

Mobile Number*

e.g. (07771)e.g. (123456)

Age (only if under 18 for safeguarding purposes)

Joint Applicant

Joint Members Name

First NameSurname

Address same as Main Applicant?

NoYes

Joint Members Address

Street Address

Street Address Line 2

Village/Town/CityCounty

Post CodeCountry

Age (only if under 18 for safeguarding purposes)

Vehicle Details (optional)

Make of Vehicle

Model

Additional Information

How did you hear about the Club?*

Membership Subscription Payment*

Yearly Single Subscription (12 months)Yearly Single Subscription (12 months)

£15 for each year

Yearly Family Subscription (12 months)Yearly Family Subscription (12 months) - 2 people living in the same household

£20 for each year

Debit/Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Permission to hold your data?*

YesMarketing Permissions

Please tick box*

Every member binds himself to abide by the rules of the Club, and also by any modifications thereof made in conformity with such rules, and also to accept as final and binding the decision of the Committee in all cases of dispute or disagreement as to the interpretation of these rules. We will issue an Membership e-card to each applicant under a separate email and as part of your Welcome email we have attached our Constitution and Rules document - please read this document.

Data collected on this form will only be used for the purpose of administration within Two Peaks Motor Club and will not be disclosed to any external sources without your express written consent. Both electronic and paper records will be deleted/shredded on your request. By completing this form and clicking/tapping Submit you agree to opting in to us using your details for event purposes only.

Two Peaks Motor Club Ltd.