PLEASE WRITE CLEARLY IN BLOCK CAPITAL LETTERS and give 21 days notice

SURNAME.

FORENAME(S).

ADDRESS IN FULL

Telephone No

Nationality

Date of Birth

Place Of Birth

Passport No

Passport Issued At

Date of Issue

Country of Destination

The cost of a Camping Carnet is €10.00 and INCLUDES COST OF RETURN POSTAGE, cheques should be made payable to the Irish Motor Caravanners' Club. Please do not sent cash or return postage.

SIGNATURE.

DATE.

MEMBERSHIP NUMBER.

RETURN TO:-

Jenny Evans, Rose Cottage, 2 Birr Road, Shinrone, Co. Offaly.