Online ROC Membership Application Form

Surname *

First name *

Wife/Partner’s name

Address *

Post Code *

Country *

Telephone (Home)

Telephone (Work)

Mobile

Email Address

Car details

This information will be help in a computer database for the purpose of keeping a historical record of the car, and club membership records.

Make

Date first registered (if known)

Registration

Model

Colour

Chassis number

Engine type

Condition (e.g. original, restored, awaiting restoration)

Recent History

About me (This will be published in the next ROC ‘Bulletin’)

Payment

Please select preferred category of membership by placing an X in the appropriate box below. Refer to the Membership page on the website www.railton.org for explanation of categories and current subscription rates.

UK Full Membership

Overseas Full Membership

Overseas Full Membership Electronic Option

UK Associate Membership

Overseas Associate Membership

Overseas Associate Membership Electronic Option

All payments must be in £’s Sterling (GBP). Please place an X in the appropriate box below. Please make cheques payable to Railton Owners Club, or pay directly to the Club bank account: Sort Code: 40-17- 04, Account number: 91009877 Overseas members please use sterling cheques, or pay directly to the Club bank account, using the international bank account number: GB52HBUK40170491009877

I have paid direct to the club bank

I am paying by cheque

I am paying by PayPal: (Please see PayPal payment drop down box at the bottom of the Membership page on the website)

I hereby apply to the Committee for membership of the Railton Owners Club Ltd, and agree to be bound by the Club Rules and Bylaws.

I agree