Black Country Classic Car Club - Online Membership Application Form

By submitting this application you give permission for any photos of your car(s) yourself or persons with you taken at shows/events to be used in the club magazine and/or the club website.

Please pay via bank transfer, details below, £10.00 Single membership £18.00 Joint membership (same address)

First name*

Last name*

First name

Last name

Address*

Post Code*

Email Address*

Second Member Email Address

Mobile phone

Alternative phone number

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Car Make

Car Model

Year of registration

Reg Number

Additional information

Submit

Once payment is confirmed new members will receive their login details for the Black Country Classic Car Club website.

Single Membership £10.00
Joint Membership £18.00

Payment can be made by bank transfer or cheque

To pay your membership fee by bank transfer please use the following details. If you are simply renewing your annual membership please include your membership number in the bank transfer reference.

Sort Code: 40-19-28
Account Number: 91776681

If you wish to pay by cheque, please send a cheque payable to Black Country Classic Car Club to Ellen Moore, 23 Sandringham Road, Halesowen, West Midlands, B62 8TJ

If you prefer you can also print out an Membership Application Form and send it by post to the address at the top of the form.

Membership will expire on 31st December of each year.

Many thanks!