The Vanden Plas Owners Club Membership Application Form

Please return completed forms to
Membership Secretary:

Bryan Peebles, The Ferns, Tripenhad Road, Ferryside, Carmarthenshire, SA17 5RS.

Membership A
No: ............................/..................

Cheque PO.
Cash Other

Please use block capitals when completing form               
Dr/Rev/Mr/Mrs/Miss/Ms (please delete)                                 
Name:     ______________________________________Postcode:__________  Telephone No:________________
Address: ____________________________________________________________________________________
email address: ________________________________________________________________________________

For the Club Archive please complete the following
Car Type & Make:_______________ Reg No: _______________Date of first registration_____________________
Chassis No: ____________________Engine No: ____________Exterior Colour ____________________________
Interior Colour ______________________________________Transmission Manual or Automatic?_____________
Type of use: Everyday, Occasional, To be restored (Delete as applicable)
Condition of vehicle: __________________________________________________________________________

PLEASE TICK THE BOXES AS APPROPRIATE

  Full Membership (U.K. & N. Ireland)

£  21.50

£

  Full Membership (1/2 year Oct-March)

£  15.50

£

  Associate Membership (Annual without car)

£  16.00

£

  Associate Membership (1/2 year without car)

£    10.00

£

  Full Membership (Overseas Annual)

£  25.50

£

  Full Membership (Overseas 1/2 year)

£  16.50

£

If you are a new member, or are rejoining, please add this admin. fee

£3.50

£

I enclose my cheque payable to V.P.O.C.

 

£

I wish to pay by Mastercard / Visa / Switch (delete as appropriate)
Card Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Card Expiry Date _ _ / _ _           Issue Number _ _ _          Card Valid From _ _ / _ _

Security Number (3/4 Digit Number on the back of the card) ___   
Name Of Bank Issuing Card . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Name And Initials Shown On Card . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes / No

 

Do you object to the club holding your membership record on computer

Yes / No

I Authorise you to undertake this credit / debit (delete as appropriate) card transaction without my presence.

Signature of cardholder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Where did you hear
about V.P.O.C.?___________________________________________________________________

SUBSCRIPTION RATES
The subscription rates shown, cover a full years subscription. For those members joining between 1st April and 1st October the full years rates apply plus the new members fee. These entitle the member to all Club Magazines, which have been published from the beginning of the subscription year and up to the end of the subscription year.

 

For those members joining after the 1st October, the half yearly rates apply plus the new members joining fee. However the reduced rate does not entitle the member to any issues of the Club Magazines which have been published from the beginning of the current year. The full years subscription becomes applicable in the normal way on or immediately after 1st April.

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