EMLRA Application Form
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Existing Members (new members please leave blank)
Membership Number:
Main Applicant
First Name:
Last Name:
Associate Applicant (must be resident at same address)
First Name:
Last Name:
Address Details
Address:
 
Town:
County/State:
Post Code/ZIP:
Country:
Telephone:
Mobile Number:
email:

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(you will be sent a link to a downloadable version of the newsletter as soon as it is sent to print)
   
Vehicle Details (we would appreciate you taking a little time to fill this in as accurately as you can. If you have no details then enter "no details")

Vehicle type:

 (eg Truck Utility ¾ Tonne, 4x4, 109”, FFR, RHD. Please state clearly whether a L/weight, 90, 110 etc).
AVC Code: (eg 1720 0778)
MOD Registration: (eg 16 GX 60)
Contract Number: (eg LV2A/004)
Date of Manufacture/
Date into Service:
Date Released from service:
Chassis Number:
Engine Type:

Known History or information of interest

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