Chester and East Clwyd Advanced Motorists
    (Affiliated to the Insitute of Advanced Motorists)

    Group Membership Application Form for Associate Members
     

    •  I wish to enrol as an Associate of the Chester & East Clwyd Group of Advanced Motorists.
    •  I agree to abide by the rules of the scheme and decisions of the Group Committee.
    •  I enclose an initial payment of £25 for one year’s Group Associate Membership; a further £45 (for IAM test and Institute Membership) will be payable at the first Associates' meeting.
    •  If you have enrolled on the Institute's Skill For Life scheme, send no money but please send the voucher with this form
    Cheques or Postal Orders should be crossed and made payable to Chester & East Clwyd Advanced Motorists.

    PLEASE FILL IN THE DETAILS BELOW IN CAPITALS

    Title_______ Initials__________ Lastname_______________________________

    Known Name _________________________

    Address ___________________________________________________________

      ___________________________________________________________

      ___________________________________________________________

      ___________________________________________________________

    Postcode ______________________

     
    Telephone (Home)_______________________ (Work)___________________________
     
    Vehicle:    Car O        Motorcycle O

      Normal Availability:  Day  O    Evening  O   Weekend O
      Age Group:  Under 30 O   30-50  O      Over 50  O
    Occupation _____________________________________________________________

    Date ________________________ Signed ___________________________________

    Introduction by / through   __________________________________________________
     

    Please send completed form and fee to:

    Mr Michael Parsonage,
    Oakmere, Mill Lane, Horseman's Green
    Whitchurch, Shropshire.  SY13 3DY   Tel: 01948 830447