FIAT 500 Club membership application form

To Join the FIAT 500 Club (UK) Fill in the form below, then print it and send both the form and your payment, either cheque (UK bank) or money order, to our membership secretary:

Janet Westcott, FIAT 500 Club, PO BOX 798, Aylesbury, Buckinghamshire HP22 9DL.

Please fill in the following fields:(fields in RED are required for us to be able to process your application.

About yourself:
Name
Address
Tel. No.
Email address
About your car:
Model
Reg No.
Year Of Manufacture
Engine No.
Capacity (cc)
Chassis No.
Colour
History	Please list any interesting history your car may have on a separate sheet.
Modifications	Please list any modifications to the standard specification, that your car may have on a separate sheet.
How did you find out about the club?
For UK residents only: Tick if you do NOT want your details held on computer.	Data Protection Act Normally your details will be held on computer. Whilst the club will under no circumstances allow this information to be used except for club purposes, if you object to such information being hold on computer please tick the box opposite
Subscription details I enclose subscription for:
full membership @ £20 per year
Associate membership @ £6 per year An associate member must live at the same address. Only one copy of 500News is sent .