| first
Name |
|
| Surname |
|
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records and will not be published) |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and will not be published) |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. |
