MEMBERSHIP FORM

UPDATED

18/04/2006

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MEMBERSHIP FORM

MODEL TYPE:- __________________________

ENGINE TYPE(+CC) __________________________

MODIFICATIONS:- __________________________

__________________________________________________

YEAR:- ______________ REG NO.:- ________________

NAME:- ______________________________________

ADSRESS:- ______________________________________

______________________________________

TELEPHONE/MOBILE NUMBER:- ______________________

EMAIL ADDRESS:- _________________________________

PLEASE PRINT THIS PAGE AND RETURN TO ADDRESS BELOW

WITH A RECENT PHOTO OF YOUR VEHICLE AND A CHEQUE

PAYABLE TO FORD LOVERS OWNERS RODDERS & DRIVERS

(FLORD) FOR THE SUM OF £12.00 PER ANNUM.

YOUR MEMBERSHIP WILL RUN FROM MARCH TO MARCH, IF YOU WERE TO

JOIN IN APRIL PLEASE DEDUCT £1.00 FROM FEE IF YOU JOIN IN MAY DEDUCT

£2.00 AN SO ON THIS IS NOW DONE TO KEEP ALL MEMBERSHIP RENEWAL IN LINE.

FLORD

18 WALSALL ROAD

CHURCHBRIDGE

CANNOCK

STAFFORDSHIRE

WS11 3JU