PENNINE LAND ROVER CLUB MEMBERSHIP FORM     PENNINE LAND ROVER CLUB LTD M  
      APPLICATION FOR MEMBERSHIP/REJOIN A  
Please fill in the opposite form making sure that you print your name and             A  
address clearly as this will be your mailing address for your club magazine      
Bottom Box' and other additional flyers                
      Mr / Mrs / Miss / Ms (please circle)    
The imformation kept is on a computer and is primarily used for printing     Members Surname        
out your address label. It may also be used to contact you urgently should     First Names          
the need arise.     Address          
                 
The information is confidential and will only be disclosed to other PLRC                
members with good reason for requesting the information. If the box is     Post Code     Tel. Number    
ticked, the information will not be disclosed. Even if the box is not ticked,     Next Of Kin     Tel. Number    
the information will not be sold,swapped or given to any other third party.     Email Address        
                 
Associate members are for family members only.     Please tick if you do not wish your info disclosed to others  
      Please tick if you object to your details being held on a computer  
      Associate Members full name (family only)    
      Mr / Mrs / Miss / Ms         
Please return completed forms to:     Mr / Mrs / Miss / Ms         
Sue Wiggan                
129 Barden Lane     Subscriptions        
Burnley     Annual (member)   £20    
Lancashire, BB10 1JD     Associate Member   £5    
Tel 01282 703718     Email markbarnes62@hotmail.co.uk     Joining Fee (New Members) £1    
      Please make cheques payable to 'Pennine Land Rover Club Ltd'
For Re-join please give your last years membership                
Member ______  Associate _______  Associate _______     I wish to join/rejoin Pennine Land Rover Club Ltd and agree to abide
Tel 01282 703718     by the club rules at all times      
                 
      Signed       Date