Application for Membership

APPLICATION FOR MEMBERSHIP 2018

Please complete the form using BLOCK CAPITALS

Return to: Margaret Mullen, 2 Coral Mews, Royton, Oldham, OL2 5PS.

Full Name(s): Date of Birth (if under 21)

Address: Post Code: Tel No: (Home) Tel No:(Business) E.mail: Mobile: Family: Partners and children (up to age 20) residing at the same address. Over age 20, Single Membership required. Junior: Age 12-20 – must have Junior membership if wishing to compete. Junior Membership NOT required for Marshalling. Please tick type of membership required and enclose payment with your application. Membership is subject to approval by the Executive Committee of the Club.

Single (£15.00) Family (£20.00) Junior (FOC) First Aid Experience (Delete as appropriate) Yes/No What are your reasons for wishing to join K.D.M.C.?

In which forms of Motor Sport are you interested in participating?

Details of Competition Car/Historic Car/Cars of Interest:

Do you intend to take part in the marshalling of events? Yes No Previous Motor Sport Associations Business/Occupation I wish to apply for membership of Knutsford & District Motor Club Ltd and I agree to abide by the rules and constitution of the Club. (I enclose a cheque/cash, cheque payable to Knutsford & District Motor Club Ltd). Signed: Date: Members meet on Monday evening at the Kilton Inn, Warrington Road (A50), Mere, for social and “Noggin” evenings. Details of forthcoming events are published in the monthly Bulletin.

DATA PROTECTION ACT: Information declared above will be held on computer for KDMC Ltd administration purposes only. This may include release to event officials.

FOR OFFICE USE ONLY Cheque/Cash Date Received Date Card Sent Membership Number