WP KLDMC Membership Application

Kings Lynn & District Motor Club
Membership application / renewal form
Application Text
Application Type*

NewRenewal
Membership Type*

SingleFamily (Member + spouse / partner + all under 18's)Full time student (under 22)Associate (Country)
Membership Type
Single
Family
Student
Associate
APPLICANT INFORMATION
Title
1st Name*
Family Name*
Mobile*
Home
Other
Address*
City*
County
Post Code*
Email*
example@example.com
Club*
Associate Membership
FAMILY APPLICANT + 1 INFORMATION
Title
1st Name
Family Name
Mobile
Email
example@example.com
Date of Birth

DayMonthYear
(only required for under 18s)
FAMILY APPLICANT + 2 INFORMATION
Title
1st Name
Family Name
Mobile
Email
example@example.com
Date of Birth

DayMonthYear
(only required for under 18s)
FAMILY APPLICANT + 3 INFORMATION
Title
1st Name
Family Name
Mobile
Email
example@example.com
Date of Birth

DayMonthYear
(only required for under 18s)
"Every member of the club undertakes to contribute to the assets of the club in the event of the club being wound-up during the time that he/she is a member, or within one year afterwards, for payments of debts liabilities of the club contracted before the time at which he/she ceases to be a member, and of the costs, charges and expenses of winding up the same, and for the adjustment of the rights of the ontributories among themseleves such amount may be required not exceeding £1.00"
SIGNATURE
Signature*
Date

DayMonthYear
PAYMENT
Payment Type*

BACSCheque

Bank Transfer (Please include Surname & Initials in the Payment Reference)
Sort Code	Account	Name
53 61 38	04048679	Kings Lynn & District Motor Club Limited

Cheques payable to KL&DMC Ltd and return to
Mrs. H Haylock	Corbiere, 18 Watlington Road, Runcton Holme, King's Lynn, Norfolk PE33 0EJ

KLDMC keeps all membership records stored on a computer for use by the club only

Kings Lynn & District Motor Club