EMLRA

EMLRA PayPal Application Form

Main Applicant
First Name:*

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Last Name:*

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Associate Applicant (must be resident at same address)
First Name:

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Last Name:

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Address Details
Address Line 1: *

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Address Line 2:

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Town:*

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County/State:

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Post Code/ZIP:*

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Country:*

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Telephone:

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Mobile Number:

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E-mail*

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You can choose to receive the Newsletter electronically (via an emailed link) or as a hard-copy
Newsletter Type:

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Vehicle Details
The EMLRA archive provides an invaluable source of information on members vehicles and has been actively maintained
for more than twenty years. We would therefore appreciate you taking a little time to fill this in as accurately as you can.
If you have no details then enter "no details".
If you have more than one vehicle you will be able to provide details of others after you have joined via the members only
area of the website.
Vehicle type:
(eg 4x4, FFR, RHD. Please state clearly whether a L/weight, 90, 110 etc).

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AVC Code:
(eg 1720 0778)

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MOD Registration:
(eg 16 GX 60)

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Contract Number:
(eg LV2A/004)

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Date of Manufacture/Date
into Service:

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Date Released from service:

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Chassis Number:

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Engine Type:

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Known History or
information of interest:

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Cost:

0.00 GBP
Publication consent
We may publish your town, county and country of residence in the club newsletter along with information about the type of vehicle/s you own. Do you consent to this?
Publication consent*

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Data protection

Please use this space to tell us specifically about any of your other details that you do not want us to publish.Invalid Input
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In EMLRA what does the 'm' stand for?*

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