Application/Renewal Form
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Type Of Membership *
Are you a new club member or renewing your membership?
If you're renewing, what was your previous membership number?
**Please only complete this if you'r renewing your membership**
Your Details
Full Name *
First name, Surname
Address
eg. 123 Fake Street, Fake Town
Postcode *
Home Phone Number
Mobile Number *
Email Address *
Your Mini(s)
Car 1 - Registration, Model, Colour
Please separate the information with a comma
Car 2 - Registration, Model, Colour
Please separate the information with a comma
Car 3 - Registration, Model, Colour
Please separate the information with a comma
Membership Fees
-The membership period starts on the 1st Jan and runs for 1 year.
-Members joining after 1st Jan will incur the full fee.
-Members who are 17 or under at the start of the membership period will get that years membership FREE. (Choose "Pay at Club")
Method of Payment *
How will you pay your membership? (If you select PayPal, please click the banner below this form AFTER clicking Submit)
Agreement
By submitting this form you are agreeing to accept the interests of Essex Mini Club and not to act in a manner that is detrimental to the clubs activities or reputation.
Submit
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