Please type your details into the boxes in the form below, and then either

• Print the form to post with your cheque or
• Click the Online Payment button to pay with PayPal.

Membership Application Form    Koren Maddison, 61 Ambleside Road, Lightwater, Surrey, GU18 5UH UK membership@the1100club.com          www.the1100club.com Applicant Name Address County/State/Country Postcode Telephone Email Vehicle Details Make/Model/Mk Body Type / Doors Date of 1st Reg/Build: Registration No Chassis/Body No Engine No Colour - Body / Trim Payment I wish to join the 1100 Club and pay with PayPal £20.50 (UK Membership)£23.00 (Europe Membership)£26.75 (Overseas Membership)   OR I wish to join the 1100 Club and print this form to send with my cheque for £20.50 (UK Membership)   I wish to join the 1100 Club and I have enclosed a cheque for £20.50 (UK Membership)