Your Name*

Address*

Post Town*

Postcode*

Telephone Number

Mobile Number

Your Email*

Privacy Policy: If mobile number is given please note that this will not be passed on to any third party, but could be used to advise of events by text messaging at no cost to yourself. Please tick those of interest below:

Autotests12 Car RalliesStage RalliesMarshalling

Fees - Please select the type of membership you require:

Single Person - £10.00Junior Member (up to and including 16yrs) - £5.00More than one person residing at the same address (Please fill in other names below) First named £10 + £5 for each other name

For applications for more than one person residing at the same address please fill in their details here:

2nd Named Person (£5). Name:

2nd Named Person. Email:

3rd Named Person (£5). Name:

3rd Named Person. Email:

4th Named Person (£5). Name:

4th Named Person. Email:

5th Named Person (£5). Name:

5th Named Person. Email:

Payment Details:

I intend to pay by on-line banking to Virgin MoneyI am paying by cheque

By submitting this form, you are indicating your agreement to the privacy policy of the Solway Car Club. Your membership is not active until we receive payment and you have received your membership card.

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