CITROEN SPECIALS CLUB

On-Line Membership Application Form

As the "Send Form" link is not working at the moment,
please print off the form, complete details
and post with your fees to:
Carole Chitty
Membership Secretary
Citroen Specials Club
8 Forest End
Fleet, Hants
GU52 7XE

Surname

First Name

Joint Member
(spouse/partner/co-builder/co-driver)

Postal address
Postcode
Telephone
Mobile or Fax Number
E-mail address
Website URL (if any)
Type of car (Make and Model)
Colour
Registration number
Donor
Name of car (if any)
Other information:
(e.g. Modifications or changes from norm.)
Car built by:
(this information is for our records and will not be published)
Car bought from - if applicable
(this information is for our records and will not be published)
Help offered: please check all applicable  
   A: Assistance with minor repairs     B: Tow to a garage
  C: Have (or can obtain) spare parts    D: Can arrange accommodation
        IN AN EMERGENCY!
   E: Languages Spoken
        (please also specify opposite)
   I am willing to be on a list of
        members able to help others with
        their build.		  
This information is used for Citroen Specials club purposes only and may be stored in a computerised system. If you DO NOT OBJECT to your details being stored in this way, send form.

 If you DO OBJECT to your details being stored in a computerised system please clear form and contact the Membership Secretary direct.

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