Lancashire & Cheshire Land Rover Owners Club

MEMBERSHIP APPLICATION 2006

(Membership is from 1st January to 31^st December)

 

Please Tick as required

Single One Member (DRIVER)                                          £25          

Joint   One Member (DRIVER) +Associate                      £35            (Associates cannot drive in events but can be a passenger)   

 

Single One Member (NON-DRIVER)                                               £20              (Member (NON-DRIVER) can be a passenger)   

                Joint   One Member (NON-DRIVER) + Associate           £30             (Associates cannot drive in events but can be a passenger)   

 

Junior(s)   (Children Up to 17^th Birthday)  per family       £2             (Details of Age restrictions are given in the Club Rule Book)

               

Please Print Clearly as all contact with you, will be from this information!

 

Member’s Full Name……………………………………………………………………………………………………………………..

Member’s preferred usual name ( eg. Andy, Jan, Bill, Sue, Jim, Cookie!)……………………………………………………………

Associate’s Full Name…………………………………………………………………………………………………………………….. 

Child(ren) Full Name(s)………………….…………….….… /  ……..………………….……..………/………………….……….……

Children’s Dates of Birth……………………………………/…………………………………………/………………………………...

Member’s Home Address…………………….……………………………………………………..……………………..….…………..

…………………………………………………….……………………………………………………………..………………………….

…………………………………………………………………………………………………......Post Code…….………..……..………

Telephone Home………………...………………...Work………………………………Mobile………………………………………….

Email Address…………………………..………………………………(Whenever practical Club information will be sent by email)

DRIVER OR NON-DRIVER?

Do you intend to drive in events in 2006?……….YES/NO

If ‘YES’, by signing below, I confirm that I hold a current RTA licence to drive a Land Rover on the public road & am not disqualified for medical or any other reason from holding such a licence.

 

Land/Range Rover Vehicle(s) Owned………………………………..…………………………………………………………………….

How did you hear about the club?      Verbal   Magazine              Website             Holly Tree           Other

               

                In the event of your illness or other emergency; who do you want us to contact?

 Name……………………………….. ……Relationship………………….………… ……..Phone…………………….…………………..

I apply for membership of the Lancashire & Cheshire Land Rover Owners Club.  I agree to abide by the rules of the Club and the

rules of all other organisations to which the Club subscribes.

 

Main Member           to sign………………………………………Date……………………

 

Associate Member    to sign……………………………………….Date…………………..

 

This information will not be passed on to third parties without your consent.

Please make cheques payable to:-  Lancashire & Cheshire LROC Ltd   and post with this form to:-      Brian Cookson (LCLROC Membership)

7 Fraser Road,

Great Sankey,      

Warrington,

                Please Email any questions to-                                                                    Cheshire WA5 3PQ