To print this page properly - use Print icon located on the page.
Please note that JavaScript has to be enabled.
Jersey Old Motor Club

 

Member Application

Level
Member (£30.00 (GBP)) Subscription period: 1 year, on: January 1st Automatic renewal: no

Membership applications have to be submitted to the committee for approval. Please allow time for this to happen.

Fill in application form

Application form

* Mandatory fields
 

 

*First name
*Last name
Mr / Mrs / Ms/ Other
Organization
*e-Mail
Phone
*Password
 
 

Contact data

 Primary member / Additional member / Honorary lifetime member
If additional member, name of primary member
Name of additional member 1
Name of additional member 2
Name of additional member 3
Address Line 1
Address Line 2
Parish
Postal code
Country
First Car Make and Model
First Car Registration
First Car Year
First car date of registration
First car type of body
First car chassis number
First car engine number
First car Horse power
First car number of cylinders
First car cubic capacity
First car Bore / stroke
First Car Picture
Second car type of body
second car Chassis number
Second car engine number
Second car horse power
Second car number of cylinders
Second car cubic capacity
Second car bore / stroke

Security check

* Code
 
Type the 6 characters you see in the picture
Captcha code image
Hear the code Try another code
Cancel
 
© Jersey Old Motor Club