MEMBERSHIP APPLICATION FORM 2005

Please complete this form and send it to:

Tony Hunt

Membership Secretary

GT40 Enthusiasts Club Ltd

Treetops

The Woodlands E-mail address: huntsen@ukonline.co.uk

Manor Road

Penn

HIGH WYCOMBE

HP10 8JD

Name:........................................................	I Wish to pay my subscription of £30:
Address..................................................... ..................................................................	By cheque, payable to GT40 ENTHUSIASTS CLUB
.................................................................. ..................................................................	Charge my (Amex/MasterCard/VISA or Switch/Maestro only) Number:........................................................ Card Expiry Date:.......................................... Card CVV No (Last 3 digits):........................
..................................................................
Membership Number:................................

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

Useful Information

Phone:	Home.........................................................................
	Work.........................................................................
	Fax............................................................................
	Mobile.......................................................................
E mail Address	..................................................................................
Occupation	..................................................................................
Specialist Skills	..................................................................................

OFFICE USE D’base Entry ........................... Starter Pack....................... B/S No....................

CAR DATA FORM

Please complete this form for our records and database

Name:................................................................................ Membership No:............................
Chassis Make e.g. GTD/KVA/TORNADO/RF	.......................................................................................
Bodyshell Make (as above)	.......................................................................................
Type: MK 1,2,3,4	.......................................................................................
Colour Scheme	.......................................................................................
Engine (brief specification)	....................................................................................... .......................................................................................
Gearbox (make & type)	.......................................................................................
Carburettor/fuel system	.......................................................................................
Wheels (make, size & type)	.......................................................................................
Tyres (make, size & type)	.......................................................................................
Accessories e.g. Air conditioning	.......................................................................................
Build Started	................................. Completion date.............................
	Will your car be on the road in 2005?................................
Build cost or purchase price	.......................................................................................
Registration Number	.......................................................................................

Please put a ring around the area you consider you live:
1. Berks/Bucks/Ox/Hants	6. North East	11. Western
2. Essex	7. North West	12. Yorkshire
3. East Anglia	8. South Coast	13. Scotland
4. London & SE	9. South West	14. Overseas
5. Midlands	10. Wales

Data Protection Act 1998

The information you have provided on this form will be stored on the Clubs membership database, which will be circulated to members during the year. It will not be sold or passed
on to third parties without your permission.

If you DO NOT want your details to be included on the membership list
circulated to members, please put an X in the box.

By cheque, payable to GT40 ENTHUSIASTS CLUB

Useful Information

CAR DATA FORM

By cheque, payable to
GT40 ENTHUSIASTS CLUB