Membership Application No:


Christian Name:


Surname:
Partners Name:


Postal Name & Address:
(e.g.. Mr. & Mrs. A.B. Clark)



Post Code:

Tel/Fax Nos:

Mobile No:

Email Address:

Vehicle Make and Model

 

Year/Registration No:
Notes/Special Features:



Are you able to offer any help?

 

Please print this form and return completed with cheque for £15 to:

Anne Obery, Membership Secretary, GEM Italian Owners Club, 6 Well Close, Long Ashton, Bristol, Somerset, BS41 9NR

(for Office use only)
Paid: £ Csh/Chq: Date: Renewal Date:

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