Membership renewal Form


Membership Renewal form

Name :
Membership no :
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