Irish Motorcaravanners’ Club

APPLICATION FOR MEMBERSHIP 2012

PLEASE WRITE CLEARLY IN BLOCK CAPITAL LETTERS

SURNAME:

FORENAME(S):

PARTNERS FULL NAME:

ADDRESS IN FULL:

NO OF CHILDREN

Under 10 _____________________

Over 10 ______________________

Telephone No

Mobile

Fax No

E mail

PIease enclose Cheque/Postal Order/Money Order for €50.00or the equivalent in Stg made Payable to: Irish Motor Caravanners' Club

SIGNAURE OF PROPOSER...................................................Membership No of Proposer.......................

Please note proposer must be a fully paid up member for 2 years and must be known to you personally.

•Only fully completed applications will be processed

•Subject to Committee Approval

•Please send all your insurance details to Stuart Insurances ltd

MEMBERS UNDERTAKING - I hereby agree to abide by the rules and code of conduct of the Irish Motor Caravanners Club. To be signed by both applicants

Signed ............................................... ......................................... Date

Signed..........................................................................................Date:

Please return to:- Jenny Evans, Rose Cottage, 2 Birr Road, Shinrone, Co. Offaly.