JZR PILOTS' ASSOCIATION

Membership Application Form

NAME:
ADDRESS:
.
.
.
POSTCODE:
TELEPHONE No:
EMAIL ADDRESS:
KIT ACQUISITION DATE:
COMPLETION DATE (or previous owner):
LONG/SHORT COCKPIT. CHASSIS No:
DONOR (Honda/Guzzi/etc.):
REGISTRATION No:
COLOUR(S):
SPECIAL FEATURES:
.
.
.

Please print the form out, complete it and send it with the fee to:

badge
Mr Tony Simpson
Caxton House
1 Station Road
Bolsover
Chesterfield
Derbyshire
S44 6BE
Tel No.01246 823895
Email:zipper1995@talktalk.net

Subscriptions are £15 p.a.
Membership Year Commences 1st January
(cheques in pounds sterling and payable to JZR Pilots' Association please)

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