Cass Beardmore & Steve Bailey, Edelweiss, Glebe Road, Kingsley, Stoke-on-Trent, Staffordshire, ST1O 2AQ.
Telephone: 01538 757183, Fax: 01538 750833, Mobile: 07710 998216.


APPLICATION FOR MEMBERSHIP 2008

NAME.................................................................................................................................................................
PARTNER'S NAME (Optional)....................................................................................................................................
ADDRESS..........................................................................................................................................................
............................................................................................................................................................................
............................................................................................................................................................................
............................................................................................................................................................................
............................................................................................................................................................................
POSTCODE.......................................................................................................................................................

TELEPHONE DAY.........................................................EVENING....................................................................
MOBILE.................................................................................................................................................................
E-MAIL................................................................................................................................................................

PERSON TO BE CONTACTED IN CASE OF EMERGENCY.............................................................................................................
TELEPHONE NUMBER.......................................................................................................................................................

Exact make and model of machine(s) to be entered, including class.
E.G. Suzuki GS1000S (1300 class) Yamaha SRX600 (Single cylinder), Yamaha RD250LC.

MAKE......................................................................MODEL............................................................................
CAPACITY..................................................................CLASS.........................................................

I enclose the sum of £15.00 which will entitle me to one years membership of the Earlystocks Racing Club.
Cheques should be made payable to Earlystocks and sent with a large S.A.E. to:

Cass Beardmore and Steve Bailey
Edelweiss
Glebe Road
Kingsley
Stoke-on-Trent
Staffordshire
ST1O 2AQ

I agree to abide by the rules and accept the decision of the committee as final. The club reserves the right to decline membership.

Signed .................................................................................................................................................................

Do you object to your details being held on computer? YES/NO

Were you a member of a racing club last year. YES/NO. If so which one(s)............................................................................................................. .....................................................................................................................................................................

Once tried - Never forgotten !