New Membership form
      
Name :

 
Home Address :

 
 

 
 

 
 

 
 

 

  Post Code :

  
Home Tel :

 
Home e-mail :

 
Mobile no :

 
      
Company Name :

 
Home Address : 

 
 

 
 

 
 

 
 

 

  Post Code :

  
Work Tel :

 
Work e-mail :

 
     

Preferred postal address*?... (please tick one)
  

 Lloyd's internal Post : 

         
 

Business : 

       
 

Home : 

      

Preferred email address*?... (please tick one)
 

Business : 

       
 

Home : 

      
    

Membership options... (please tick one)
  

Life - £120.00 : 

         
 

Annual - £20.00 : 

      
 

Annual - £17.50 : 

    ... when paid by standing order
    

Please complete this form and send to ... 
  The Membership Secretary
Lloyd's Motor Club
Lloyd's
One Lime Street
London
EC3M 7HA 

Please enclose either a cheque made payable to "Lloyd's Motor Club" or a completed standing order mandate which we will send to your bank. The membership secretary will send confirmation of you membership as soon as possible.
Signed : 

 
Dated : 

 

 
* The club will not pass on any details supplied to any third parties