Wolverley & District Driving Club Membership Form
Application for new / renewal membership with Wolverley & District Driving Club
Membership fees are due on date of Annual General Meeting (AGM) each year
Membership Type
Please select your type of membership
*
Family Membership - (Includes all adults and children residing in the same house) £50.00
Joint membership (two adult drivers in the same household) £40
Single membership £30
Junior membership (under 18 on 1st Jan) £15
Non-driving membership £10
Payment Details
Payment details
Cheque made payable to WDDC (please send to Linda Sprosen 156 Birmingham Road, Kidderminster, DY10 2SL). Or by BACS to Account 51276859 Sort Code 40-26-08, account name WDDC.
Payment being made by
*
Cheque
BACS
Amount paid
*
£50
£40
£30
£15
£10
Adult member details
Member One Title
Member One Name
First Name
Last Name
Member Two Title (joint & family membership)
Member Two Name (joint & family membership)
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Member One Email
*
example@example.com
Member Two Email
example@example.com
Member One Mobile Number
-
Area Code
Phone Number
Member Two Mobile Number
-
Area Code
Phone Number
Alternative Number
-
Area Code
Phone Number
Junior member details
Junior member one name
Junior member one DOB
-
Day
-
Month
Year
Date Picker Icon
Junior member two name
Junior member two DOB
-
Day
-
Month
Year
Date Picker Icon
Type name as signature
Carriage details
Details of carriage (make, model, 2 or 4 wheels
Pony / Horse details
Pony / horse One name
Pony / horse One height (hh)
Pony / horse Two name
Pony / horse Two height (hh)
Pony / horse Three name
Pony / horse Three height (hh)
Pony / horse Four name
Pony / horse Four height (hh)
Insurance details
Insurance details
Policy Number
Date of renewal
BDS membership (if applicable)
BDS member number
Signature and date submitted
Type name as signature
Date submitted
*
-
Day
-
Month
Year
Date Picker Icon
Press to send
Should be Empty: