THE VINTAGE MOTOR CYCLE CLUB LIMITED

MEMBERSHIP APPLICATION

Subscription Rates (inclusive of £3.00 joining fee)

Name _______________________________________________________________________________

Address _____________________________________________________________________________

____________________________________________________________________________________

________________________________________________ Postcode ___________________________

Tel. No. _____________________ E-mail Address __________________________________________

Date of Birth: ____________________________________

Additional family members residing at the above address:

Full Name __________________________________________________________________________

Signature _____________________________________ Date of Birth: __________________________

Full Name __________________________________________________________________________

Signature _____________________________________ Date of Birth: __________________________

Full Name __________________________________________________________________________

Signature _____________________________________ Date of Birth: __________________________

Cheques & Postal Orders to be made payable to The Vintage Motor Cycle Club Ltd.
or by Debit, Credit, Visa or MasterCard (no Electron or American Express).

Amount £ _________ Card Number ______________________________________ Expiry __________

Start date _______________ Expiry date ______________ Issue No. (where applicable) ___________

Card Holders name ________________________________ Signature __________________________

I do not wish my details to appear on the published membership list (tick here) [ ]

I hereby apply to become a member of the above named Company limited by guarantee and hereby
undertake to contribute to its assets in the event of the Company being wound up whilst I am a member
thereof or within 12 months of my ceasing to be a member, the sum of One Pound (£1.00) in accordance
with Clause 5 of the Company's Memorandum of Association.

Signed __________________________________________ Date ______________________________

Please print, complete and post this form to:

THE VINTAGE MOTOR CYCLE CLUB LIMITED
Allen House, Wetmore Road, Burton Upon Trent, Staffordshire, DE14 1TR