Austin Cambridge/Westminster Car Club

Application for Membership (web)

Please print out this form, fill it in and send it with your subscription and an A5 sized Self Addressed Envelope to: Jim Curtis, 4 Russell Close, East Budleigh, Budleigh Salterton, Exeter, Devon. EX9 7EH United Kingdom  If you have further vehicles, please send details on another sheet.  Note: all prices in UK pounds sterling.  We accept payment in UK Pounds Sterling by cheque in drawn on a UK bank, by UK Postal Order or by International Money Order in UK Sterling. Please make cheques payable to Austin Cambridge/Westminster Car Club or ACWCC Name:   Address & Country:     Postal/Zip Code: Date: Telephone Number:   E-Mail Address:   Subscriptions and Regalia Please enter totals: Annual Subscription 2005  £19   Half year subscription (July-December)  £10   3 Year subscription (to end 2005) £51.00   Keyring £2   Car Badge £7.50   Post and Packing – EEC (inc. Eire) £1.50   Post and Packing – Outside EEC £3.50   Total value of cheque/PO enclosed:   Spares required: (please include a phone number etc. if possible) Vehicle Details Make: (Austin, Wolseley etc)   Model: (A60, 6/110 etc.)   Type: (Saloon/sedan, Estate/Station wagon etc.   Registration Number:   Colour:   Date first registration:   Chassis Number:   Engine Number:   History of Vehicle: Office Use DR MN CC RD MC JP MD VD SN RR OR