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 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

 

   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 number on the back.

   SEND FORM AND PAYMENT TO:

   MEMBERSHIP SECRETARY: SHARON ATKINSON

   16A SALOP ROAD

   OSWESTRY

   SHROPSHIRE

   SY11 2NU

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

 

   VISIT US AT: www.muddymillers.com