Lincs Off Road

Membership Form

2011/12

This form is to declare that the person listed below has donated £20 to the Lincs Off Road Club, which entitles them to the club news letters.  Membership renewals are annually from the date of joining.

First Name ...............................................................       Surname.........................................

Address....................................................................................

              ………………………………………………………

              ………………………………………………………

              ………………………………………………………

Postcode...................................

Telephone................................................         Mobile.................................................

Email.....................................................................

Vehicle......................................    Reg No………..........................

Sign ……………………..……………………….

Membership is £20 Per Year

Make Cheques Payable to Lincs Off Road

 For official use                                                         Please return payment and form to:

The Membership Secretary

Membership No 80 Church Lane

Kirkby La Thorpe

Form Received    /    /                       Sleaford

Lincolnshire

    NG34 9NU

Card Issue Date   /    /