Muddy Millers 4x4 Club

APPLICATION FOR MUDDY MILLERS 4X4 CLUB 2009

THE INFORMATION BELOW IS REQUIRED FOR MEMBERSHIP. THE DETAILS WILL BE

USED TO RUN THE CLUB ACCORDING TO THE INTERESTS OF OUR CLUB MEMBERS.

PLEASE WRITE CLEARLY AND USE THE REVERSE OF THIS FORM IF NECESSARY.

THANK YOU.

SINGLE MEMBERSHIP £20.00 I CONFIRM ALL MEMBERS LISTED BELOW WHO WILL COMPETE IN

TRIALS HOLD A FULL UK DRIVERS LICENCE.

FAMILY MEMBERSHIP £30.00 (FOR UPTO 3 NAMED DRIVERS, IMMEDIATE FAMILY ONLY. £10 PER

EXTRA DRIVER THEREAFTER,MAX 3 EXTRA DRIVERS)

NAME: D.O.B

FULL ADDRESS (INCLUDING POSTCODE): TELEPHONE NO:

MOBILE NO:

EMAIL:

FAX:

VEHICLE (S):

AREAS OF INTEREST: GREEN LANING TEAM CHALLENGE TRIALS COMP SAFARI

OTHER (PLEASE SPECIFY):

OCCUPATION: IF YOU WOULD LIKE TO ADVERTISE THIS TO CLUB MEMBERS OR IF

YOU KNOW OF ANY LINKS OR SUPPLIERS THE CLUB MAY BENEFIT FROM PLEASE LET THE SECRETARY KNOW

PROJECTS YOU ARE INVOLVED WITH OR WOULD LIKE TO HEAR ABOUT e.g. RESTORATIONS, BUILDING

TRIALLERS,ETC.

DO YOU HAVE ANY SUGGESTIONS FOR FUTURE EVENTS???

NO INFORMATION WILL BE DISCLOSED FOR ANY OTHER PURPOSE THAN THAT OF THE CLUB. IF YOU DO

NOT WISH YOUR DETAILS TO BE INCLUDED IN THE NEWSLETTER THEN PLEASE TICK THE BOX.

WOULD YOU LIKE TO RECEIVE YOUR NEWSLETTER BY E-MAIL.? IF SO PLEASE TICK THIS BOX

CONTACT US IF YOU WOULD LIKE ANY INFORMATION SENDING TO A FRIEND.

MAKE CHEQUES PAYABLE TO ‘MUDDY MILLERS 4X4 CLUB’. Please put card number on the back.

SEND FORM AND PAYMENT TO:

Getting Dirty For Fun. MSA Recognised. Est Over 10 Years.