MINI COOPER REGISTER - MEMBERSHIP APPLICATION FORM

SURNAME ________________________________________ Mr/Mrs/Miss FIRST NAMES____________________________

PARTNERS NAME (If joint membership required) _______________________________________________________

ADDRESS_____________________________________________________________________________________________

COUNTY_______________________ POST CODE _______________________ COUNTRY ____________________________

TEL. NO _____________________ PROFESSION ______________________ YEAR OF BIRTH ______________________

email address _____________________________________________________________________

I am interested in:  Concours/Restoration ______ For Sale & Wanted ______ Motor Sport ______________

Reprinted Articles ______________ Social Events __________ Helping run my local region _____________

I currently hold/do not hold an RAC Competition Licence (delete as applicable)

How did you first hear about the Mini Cooper Register?______________________________________________

From whom, or where, did you receive this application form? the internet

CAR DETAILS Year __________ Make ____________ Model _______________ Mark ________ cc _________

Colour: (Body) ___________ (Roof) ___________ (Interior) __________ Reg No. __________________

I hereby apply to become a member of the MINI COOPER REGISTER and I agree to abide by its Rules and 

regulations.

I enclose a PO/Cheque (Payable to the Mini Cooper Register) for £_____________________________

(NB Europe/Rest of the World Applications - Sterling Cheques/Drafts only Please)

I wish to pay by Mastercard/Visa. Please debit my credit card account with the amount £ ____________

My Mastercard/Visa No is |__|__|__|__| |__|__|__|__| |__|__|__|__| |__|__|__|__|

If paying by Mastercard/Visa please complete the following:

NAME (as on card) ________________________________________________ Expiry Date of Card _____________

Cardholder's Address _______________________________________________________________________________

____________________________________________________________________________________________________

ALL APPLICANTS PLEASE COMPLETE THE FOLLOWING

SIGNED _________________________________________________________ DATE ______________________________

Please return the completed form to: Lesley Young, Membership Secretary,

MCR, Spring Cottage, Small Hythe, Tenterden, Kent TN30 7NE. UK.