MEMBER APPLICATION

 

FIAT Club Africa

MEMBERSHIP RENEWAL AND APPLICATION FORM  2011

                

 

Tel:  (028) 273 8850,         Fax:  (028) 273 8850.                    E-mail:  abiefullard@gmail.com

 

Please deposit payments to the account below and fax or email the deposit / payment slip.

              Fiat Club Africa, Acc 424805685, Standard Bank, Sandton Branch (Code 01 92 05)

Fiat Club Africa caters for all cars made by the Fiat Auto organization and its subsidiaries as well as specialist vehicles made from a Fiat base.  Fiat was established in 1899 has always been at the forefront of automobile design and engineering and is a world leader in materials technology. The most usual Fiat Club membership category is “Individual” and this provides full access to the club facilities as do the categories of Pensioner and Student for those with qualifying status. Individual Membership includes Membership of spouse or partner. The club’s support dealers offer bona-fide members special deals on all aspects.

The membership year is from January to December. 

 

Please fill out the Membership Application Form

*Minimum required fields

 

*First Name:

 

*Surname:

 

Preferred Contact No:

 

*Cell:

 

*E-mail:

 

Fax:

 

Postal Address:

 

Province:

 

Postal Code:

 

Partner Name & Surname:

 

Birth Date Self:

(Year is optional)

Birth Date Partner:

(Year is optional)

 

 

 

 

Fees due by 1st January - *Please enroll / renew me as:

       

I have the following Cars:

      
  Car 1 Car 2 Car 3
Make:  
Model:  
Series:  
Engine size cc :  
Year made:  
Official dated Y/N:      
Reg. No.:  
Body No (if applic.):  
Colour:  
Drive side L/R:      
Condition *:  

Club Insurance Y/N:

 

Fire Extinguisher Y/N:

 

 

 

 
I would like to participate in:      
Social: Picnics:
Rallies: Motor sport:
Technical discussions:    
       

I agree to abide by the rules and constitution of the club & maintain the honor of the club at all times.

 

I have read and understood the SOUTH AFRICAN MARQUE CLUB ASSOCIATION DECLARATION OF ASSUMPTION OF RISK AND INDEMNIFICATION

 

By Submitting this form I agree to the rules and constitution of the club and the Declaration of assumption of risk and indemnification

 

Membership will only be accepted once payment has been confirmed.

Please deposit payments to the account below and fax or email the deposit / payment slip.

Fax:  (028) 273 8850.                    E-mail:  abiefullard@gmail.com

Fiat Club Africa, Acc 424805685, Standard Bank, Sandton Branch (Code 01 92 05)

 


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