APPLICATION FOR RENEWAL OF MEMBERSHIP 2012

PLEASE WRITE CLEARLY IN BLOCK CAPITAL LETTERS

THIS FORM IS FOR RENEWAL ONLY AND NOT FOR NEW MEMBERS. NEW MEMBERS FORM IS AVAILABLE DIRECT FROM MEMBERSHIP SECRETARY. ALL APPLICATIONS FOR NEW MEMBERSHIPS ARE SUBJECT TO CLUB COMMITTEE APPROVAL.

SURNAME:

FORENAME(S):

PARTNERS FULL NAME:

ADDRESS IN FULL:

Telephone No

Mobile

Fax No

E mail

I enclose Cheque/Postal Order/Money Order for €40.00 or the equivalent in Stg made Payable to: Irish Motor Caravanners' Club

ANNUAL SUBSCRIPTION FALLS DUE ON 1 ST JANUARY 2012

I agree to abide by the Constitution and Code of Conduct of the Irish Motor Caravanners' Club.

SIGNATURE.

DATE.

MEMBERSHIP NUMBER:

RETURN TO:- Jenny Evans

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

PLEASE DO NOT SEND CASH