HGPCA Membership Application

Membership Application Form

I wish to apply for membership of the Historic Grand Prix Cars Association
Membership Type applied for:

FULL Membership (owners of Grand Prix cars only) £500/€570ORDINARY Membership - DRIVING £500/€570ASSOCIATE/FAMILY Membership £200/€228
For Full or Ordinary Membership, a Joining Fee of £500/€570 is payable only once plus your Annual Subscription
Last Name
First Name
Preferred Email Address
Alternative Email Address
Address

Street Address

Street Address Line 2

CityCounty

Postal / Zip CodeCountry
Mobile Number:
Telephone Number:
Proposed By: (not required for Associate Membership)
Name of Full or Life Member
Proposer's Signature

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Seconded By: (not required for Associate Membership)
Name of Full or Life Member
Seconder's Signature

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Is your membership dependent upon your car being acceptable in HGPCA races?
I agree to abide by the Rules and Regulations of the Association

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Driver/Entrant Details

Please complete this information which is for our files and not for general circulation. The additional details are requested in order to simplify the race entry form.
Name
First and Surnames as shown on Race/Entrants Licence
Date of Birth
Nationality
Race Licence Number
Race Licence Type
ASN issuing licence
Occupation
Blood Group
Next of Kin

Please give name and contact details
In case of injury, please inform
Give the full name of your next of kin
Relationship
Contact Telephone Number
Additional Next of Kin Name and Telephone Number
Commentator Notes (Details of racing to date including any successes and the year you started racing etc)
This information is kept in the members' database and may be given to Race Organisers to save you completing forms for individual events.
Please upload a copy of the front and back of your current race licence

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Please upload a head and shoulders photograph of yourself

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Car Details

Please complete all the details where possible, especially the brief history of the car in period and its best results. Enter the HTP number and expiry date and upload a copy of the papers. To add more cars, please select this option at the end of this form.
Marque and Model
Year
Chassis Number
Colour
Transponder number
Preferred Race Number(s)
FIA HTP No:
FIA HTP Expiry Date
Please upload a complete copy of the current HTP papers

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Please describe a brief history of the car in period with best results
Previous Owners
Recent History
Wheel Diameter Front
Wheel Diameter Rear
Wheel Width Front
Wheel Width Rear
Tyres
Rear or Front Engined
Engine Manufacturer
Engine Number
Engine Year
Number of Cylinders
Engine cc
Is the engine supercharged?
Preparer Name
Preparer Email Address
Preparer Telephone Number
Please select to add further cars

Add another car

Car Details

Please complete all the details where possible, especially the brief history of the car in period and its best results. Enter the HTP number and expiry date and upload a copy of the papers. To add more cars, please select this option at the end of this form.
Marque and Model
Year
Chassis Number
Colour
Transponder number
Preferred Race Number(s)
FIA HTP No:
FIA HTP Expiry Date
Please upload a complete copy of the current HTP papers

Cancelof
Please describe a brief history of the car in period with best results
Previous Owners
Recent History
Wheel Diameter Front
Wheel Diameter Rear
Wheel Width Front
Wheel Width Rear
Tyres
Rear or Front Engined
Engine Manufacturer
Engine Number
Engine Year
Number of Cylinders
Engine cc
Is the engine supercharged?
Preparer Name
Preparer Email Address
Preparer Telephone Number
Please select to add further cars

Add another car

Payment will be made by:

Sterling Bank Transfer: Sort Code: 301393 Account No: 51513101 BIC/SWIFT code: ARBUGB2L IBAN: GB81ARBU30139351513101Euro Bank Transfer: Sort Code: 301393 Account No: 20003113 BIC/SWIFT code: ARBUGB2L IBAN: GB23ARBU30139320003113Credit or Debit Card

Membership Application Form