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 Affiliate Membership Overseas Affiliate Membership Overseas Affiliate 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: GB15MIDL40170491009877 * 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 Note also that you can join the Club, and renew your subscription, using your credit/debit card or Paypal account from the website. (There is a 4% surcharge for using this facility –See details on the membership page of railton.org ).