THE DAIMLER ENTHUSIASTS CLUB
MEMBERSHIP FORM AND CHASSIS REGISTER

NAME                                                                 OUR REF:………
 

ADDRESS

POST CODE……………….E-MAIL ………………………………….……….…
PHONE NUMBER...........

FAX NUMBER…………………….
MAKE: MODEL:....................................................................…
REGISTRATION NO: YEAR:.....................................................................….
CHASSIS NO: ENGINE NO:..........................................................….
BODY NO: BODY TYPE: (e.g. DB18).................................…..
BODY COLORS/S: INTERIOR COLOR/S:...........................................…
POWER STEERING YES/NO (delete as necessary) CONDITION:..........................................................….
ROAD WORTHY YES / NO (delete as necessary) LAST USED ON THE ROAD:..............................……
PRICE PAID:……………………………………………….POINTS OF INTEREST:
ANY INTERESTING HISTORY
…………………………………………………………….(If additional space is needed please write overleaf)
ANY OTHER DAIMLER MODELS LIST HERE
A PHOTOGRAPH FOR RECORD WOULD BE APPRECIATED IF AVAILABLE

DATE EXPIRY DATE....................

ANNUAL SUBSCRIPTION : UK MEMBERS £26 - OVERSEAS MEMBERS £29 (Bankers draft/Cheque)
(Second year only UK MEMBERS £22- OVERSEAS MEMBERS £25 For Standing orders rate only)
(Delete as necessary)
Please return to: MR J.R NASH, 100-102 FAIRMILE ROAD, CHRISTCHURCH, DORSET, BH23 2LN.

PLEASE MAKE OUT ALL CHEQUES TO: THE DAIMLER ENTHUSIASTS CLUB

NOTE: All information is confidential and only used to keep the register up-dated. Thank you for your help

_{FOR OFFICE USE ONLY 10/10/2011}

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