FiatPandaClub Application Form

The FiatPandaClub

APPLICATION FORM

By applying to become a member of the FiatPandaClub and therefore associate member of the Fiat Motor Club (GB), you automatically agree to abide by the rules of the Fiat Motor Club (GB). The completed application form should be printed (click on 'Print Form' Button at the bottom of the form) and posted with your payment (UK: £25, EEC: £32, ROW:£35) to:

The FiatPandaClub, 45 Connaught Gardens, London N10 3LG, UK

Full Name
Address



Postcode	Tel. (Home) Tel. (Work)
Email
	The Club occasionally publishes various members' lists to allow its members to communicate. If you do not want your details included in any lists published by the club, please tick here The Club may pass members' details to third parties who have motor related offers of interest. If you do not wish your name passed on in connection with motor related offers please tick here

Model(s) of Panda
Registration Number(s)
Year of Manufacture
Are you a member of the RAC? Yes No

Partner / Nominated member

Full Name
Address



Postcode	Tel. (Home) Tel. (Work)
Email
	The Club occasionally publishes various members' lists to allow its members to communicate. If you do not want your details included in any lists published by the club, please tick here The Club may pass members' details to third parties who have motor related offers of interest. If you do not wish your name passed on in connection with motor related offers please tick here

PAYMENT OF £25 FOR UK, £30 FOR EUROPE AND £35 REST OF WORLD

SHOULD BE BY CHEQUE OR POSTAL ORDER CROSSED AND MADE PAYABLE TO

'FIAT MOTOR CLUB (GB)'.

FOR PAYMENT BY CREDIT CARD CALL PETER JONES ON +44 (0)20 8372 4028