Join the 2CV Racing Club Ltd online

Please complete all fields in bold. Please note that after submitting this form you will be taken to PayPal, where you can either complete the payment by logging into your PayPal account, or you can pay by credit/debit card if you don’t have a PayPal account. Please do not use this form for submitting payment by bank transfer (BACS) !

Your name: Email address:
Address line 1: Address line 2:
Address line 3: Town:
County: Postcode:
Telephone 1: Telephone 2:
Date of Birth (DD/MM/YY): Nationality:
Next of Kin: NoK Phone:
NoK Address:    


Membership type: RacingFull Team name:
MSA Licence #: BARC Member #/expiry:
Car number: Alternative car #s:
I wish to also join the old, defunct "club" - only to be used if you intend to come to the March 2017 EGM: (yes)


Declaration:

I wish to register for the 2CV Parts.com Championship and I declare that the information given above and over is correct. I understand that should the above information change in any way I will confirm details in writing to the BARC (via the Classic 2CV Racing Club Ltd).

By applying for membership of the Classic 2CV Racing Club Ltd I acknowledge that I will become a shareholder in the company and give a guarantee of up to £1 that applies for the duration of my membership and for a period of 1 year thereafter.

I agree to abide by the Classic 2CV Racing Club Ltd's rules and regulations:

Note: Full Membership – £60 (+£2.50 card/Paypal charge) - full voting rights at AGM, receive technical bulletins, social invites, Snails Pace Magazine and discount on merchandise but no racing number. Racing Membership - £60 (+£2.50 card/Paypal charge) - as full membership but allocated racing number. Social Membership - as full but no voting rights at AGM nor technical bulletins - this form cannot be used for Social Membership, please use this form instead.