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ACOC Membership - Please complete, print out the form and return with your full remittance to:
Bob Langley, 47 John Rennie Road, Chichester, West Sussex, PO19 8FD

OR join or renew with PayPal online on our online registration page >>>> click here.

 

Surname

Forename(s)

Address

 

Postcode / Zip

Telephone

Email

'I, the undersigned, hereby apply for membership of the AC Owners' Club Ltd and undertake to be bound by the Memorandum and Articles of Association of that Company. I understand and agree that my name, address and car ownership details may be processed and used for Club purposes only as stated in the Data Protection Act Notice displayed on this website.'

Signature ................................................................................ Date .................................

Car Details (ACs only, please!)

Year

Model

 

Chassis No.

Present
Engine Type

   Engine No.

Reg No.

Mileage

   Overdrive - Yes/No

Modifications

   Date of Purchase

Condition at
Time of Purchase

Price Paid (this information remains strictly confidential)

Colour

Interior

   Gearbox type


Subscriptions may be paid either by Sterling Cheque, Dollar Cheque, Visa or MasterCard - see below

Entrance Fee

@ £2.50 or $5   

Subscription UK

@ £40   

Subscription Europe

@ £50   

Subscription any other country (Sterling/Dollar cheque or Credit Card)

@ £60 or If paying in US Dollars please convert at the current exchange rate

Plus any regalia (see regalia order form)

£   

Cheques made payable to: AC Owners' Club Ltd.

TOTAL £   

Card Number...............................................................................

 

Expiry Date..................................................................................

 

3 Digit Security Code...................................................................

 

Cardholder's Name......................................................................

 

Cardholder's Signature.................................................................