LANDROVER CAMPING & CARAVAN CLUB

Member of the British Leyland Camping and Caravan Association

Exemption Certificates Issued by:

The Department of the Environment

The Scottish Office

The Welsh Office

                                                                           MEMBERSHIP APPLICATION FORM

(Please print details)                                                                                                                      Date:

SURNAME:______________________________________________MR/MRS/MS (please delete)

FIRST NAMES:_________________________________________________________________

SPOUSE/PARTNER NAME_______________________________________________________

ADDRESS:______________________________________________TEL No:________________

                    ______________________________________________POSTCODE:____________

TENT                              CARAVAN                         MOTORHOME           

LAND ROVER EMPLOYEES - DETAILS:

Location of Employment:       _______________________________________________________

Section/Dept. location:          _______________________________________________________

Internal Tel No:                      _______________________________________________________

NON - LAND ROVER EMPLOYEES:      If vacancies permit

Enter the name of a Land Rover Employee who will be your sponsor:

NAME OF SPONSOR:_____________________________________CLUB MEM No:_________

IF YOU HAVE BEEN A MEMBER OF ANY BRITISH LEYLAND CAMPING & CARAVAN ASSOCIATION

CLUB, PLEASE GIVE DETAILS ON BACK OF FORM

SIGNATURE:_________________________________

Please send club membership fees of £15 for existing members

New membership fees are £15 plus initial joining fee of £1.00, Total fee £16.00

To:          Mr Ron Tame

                66 Foden Raod

                Great Barr

                Birmingham

                B42 2EW

Tel:         0121 358 4452

Please make cheques & postal orders payable to:   LAND ROVER CAMPING & CARAVAN CLUB

LRHME1:09 October 2006