www.mk1-5cortinaownersclub.co.uk

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Title

Name

 Body Style

Marque

Surname

Address Line 1

Post Code

 Tel: No.

Mobile No.

       E-Mail Address

Website Forum User Name

Model

 Colour

Engine Size

Chassis Number

Transmission

 Reg. Number

  Brief History  or

   Modifications

    Line 3

       Line 2

Subscription is from April  to April

The subscription fee for a full year is £15

 If you are joining part way through the year please contact the Membership Dept. for the relevant subscription fee.

POSTAL MEMBERSHIP APPLICATION /  RENEWAL FORM

 Would you like to have your   car considered for possible   photo/film shoots in the   future?


Please make your cheque payable to:

The Ford Cortina Owners Club


Please print off this form and together with your cheque send it to:

Anne Dickinson

Membership Department

5 Cromer Road,

Bispham,

Blackpool,

Lancs,

FY2 0ED.


Tel: 01253 356068

E: j_a.dicki-5@talktalk.net

TTYPE OF APPLICATION

FOR OFFICIAL USE ONLY


Cheque No:_____________


Amount Paid:___________


Date Received:_________


Membership No:________

All member details are strictly confidential, and will not be conveyed in any manner whatsoever to a third party without the sole and express permission of the member.

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