MIDLAND VEHICLE PRESERVATION SOCIETY.

MEMBERSHIP APPLICATION

NAME ………………………………………………….……………..……………………

ADDRESS ……………………………………………....………………………………....

………………………………………………………………………………………………

POST CODE……………………………………………………………………………….

TELEPHONE NUMBER ………………………………………………………………….

E MAIL ADDRESS …………………………………………………….…………….……

DETAILS OF VEHICLES OWNED

MAKE AND MODEL ……………………………………………………………………..

YEAR …………………………SIGNATURE ……………………..……….……………

MEMBERSHIP SUBSCRIPTION INCLUDES IMMEDIATE FAMILY.

AND FALLS DUE ON 1ST MARCH ANNUAL SUBSCRIPTION £22.00

PLEASE RETURN TO

DAVID BATEMAN (MEMBERSHIP SECRETARY)

34 RUTHERGLEN AVE, COVENTRY, CV3 4DG

TEL/FAX (024) 76 30 20 80

E.MAIL aerial.electrical@virgin.net

Please print the page and fill it in.

Then send it to Dave at the above address