Muddy Millers 4x4 Club

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

Membership Form              Please print out, fill in and send to address below

 

APPLICATION FOR MUDDY MILLERS 4X4 CLUB 2008

 

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 £25.00     I CONFIRM ALL MEMBERS LISTED BELOW WHO WILL COMPETE IN

                                       TRIALS HOLD A FULL UK DRIVERS LICENCE.

FAMILY MEMBERSHIP £30.00     ( FOR 2 NAMED DRIVERS IMMEDIATE FAMILY ONLY,£10 PER EXTRA    

                                         DRIVER THEREAFTER,MAX 3 DRIVERS)

NAME:                                                     D.O.B

 

NAME:                                                     D.O.B

 

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 no on the back SEND FORM AND PAYMENT TO:

MEMBERSHIP SECRETARY:

DAVID ATKINSON

11 LLYS AVENUE

OSWESTRY

SHROPSHIRE

SY11 2XE

(membership card will be presented at next club night after application received,along with a welcome pack)

 

VISIT US AT: www.muddymillers4x4club.co.uk www.muddymillers.com

CONTACT NUMBER FOR INFORMATION AND ANY QUERIES: 0845 094 2392