Membership Form / Renewal Form for 2017

AMICALE FACEL VEGA Membership Form / Renewal form for 2017

Dear Facellist Friend,

Welcome to Amicale Facel Vega ! In order to record your membership, would you please fill in the following form. The characteristics of your Facel ( see overleaf ) will allow us to update the Facel register. ------

Name : Address : First name: Date of birth: Occupation: City : Tél. Office : Area Code : Tél. Home : Country: Tél. cell. : E-mail : Fax :

Do you authorize Amicale Facel Vega to publish your personnal references in the Directory: YES / NO

MEMBERSHIP 2017 NEW MEMBER 75 Euros NB: Membership fees paid after the 30th September 2016 will count for 2017

RENEWAL - 2017 Before the 31st of March, 2017 ( 10 Euros discount ) 65 Euros After the 31st of March, 2017 75 Euros

Benefactor Member 150 Euros minima

Payment by - Check (French bank) - Bank transfer to the Amicale Facel Vega bank account : B.N.P. Paribas – 1 rue de la République – F 78100 Saint Germain en Laye (IBAN « FR 76 3000 4001 7800 0101 0481 692 » - Swift code « BNPAFR PPLAY »)

Please send back to : Michel REVOY – 12 Allée de la bécassine – F 64230 Sauvagnon Tel. / Fax. : (33)6 47 29 92 28 E-mail : [email protected] AMICALE FACEL VEGA Membership Form / Renewal form

TYPE & CHARACTERISTICS OF YOU FACEL-VEGA OR FACEL-METALLON

Car 1 Car 2 Car 3 MAKE

TYPE :

BODY: Coupé / Convertible / Coupé hard top / Berline CHASSIS Number : PRODUCTION Number : ENGINE Number:

GEAR BOX : Auto / Méca Date of delivery :

COLOR : Body / Roof Intérior

UPHOLSTERY: Leather / Skai

1st Owner

Ex-owners

Options

AMICALE FACEL-VEGA 30 rue Maurice Ravel – 17100 LES GONDS ( France ) Tel. & Fax. : (33)6 47 29 92 28 - E-mail : [email protected] Membre de la Fédération Française des Véhicules d'Epoque (F.F.V.E.), affiliée à la Fédération Internationale des Véhicules Anciens (F.I.V.A.). Membre du Club des Marques