[GTM OC Logo] Please Return to:
Membership Secretary
1 Callcott Drive
Quarry Bank
Brierley Hill
West Midlands
DY5 2NF
Phone Number.......................................

Email Address......................................		 Name.....................................................
Address..................................................
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Postcode.................................................
Car Use (Ring as appropriate)

EVERYDAY / LEISURE / SUMMER ONLY / COMPETITION

Model (Ring as appropriate)

COUPE / ROSSA 1 / ROSSA 2 / K3 / LIBRA

Registration No............................. Chassis No.................................. Colour......................................
Engine type & size.................................................................................................................................
Self Built?............................... Date Purchased............................ Date Registered...........................

The subscription is £10.00 per year.
The preferred method of payment is by standing order as this is easier for both parties and this can of
course be cancelled at any time. A standing order form will be sent to you if you indicate you wish to pay
by this method below.

Paying by Standing Order? (preferred method of payment).................................

If you prefer to pay by cheque, please make the cheque payable to "GTM Owners Club" with
subsequent payments due on the anniversary of the joining date.

PLEASE READ AND SIGN

1) I agree to abide by the Rules and Constitution of the GTM Owners Club.

2) I agree to my details being held on a computer database. I understand that no data will
be disclosed to any third party other than in the normal running of the Club.


SIGNED......................................................... DATE.................................

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