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


NAME.................................................................................................................................................................
ADDRESS..........................................................................................................................................................
............................................................................................................................................................................
............................................................................................................................................................................
............................................................................................................................................................................
............................................................................................................................................................................
POSTCODE.......................................................................................................................................................

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

Exact make and model of machine(s) to be entered, including class.
E.G. Suzuki GS1OOOS Modified or RD400E Production.

MACHINE ..........................................................................................................................................................

BRIEF DESCRIPTION OF MODIFICATIONS....................................................................................................
............................................................................................................................................................................

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:

Steve Bailey and Cass Beardmore
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.

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

Do you object to your details being held on computer? YES/NO
Which clubs were you a member of last year? EMRA / Darley Moor / Other..................................................

Once tried - Never forgotten !