EMLRA PayPal Application Form
  1. Main Applicant
  2. First Name:*
    Please type your first name.
  3. Last Name:*
    Please type your last name.
  4. Associate Applicant (must be resident at same address)
  5. First Name:
    Please type your first name.
  6. Last Name:
    Please type your last name.
  7. Address Details
  8. Address Line 1: *
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  9. Address Line 2: 
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  10. Town:*
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  11. County/State:
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  12. Post Code/ZIP:*
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  13. Country:*
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  14. Telephone:
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  15. Mobile Number:
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  16. E-mail*
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  17. You can choose to receive the Newsletter electronically (via an emailed link) or as a hard-copy
  18. Newsletter Type:
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  19. 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")
  20. Vehicle type:
    (eg 4x4, FFR, RHD. Please state clearly whether a L/weight, 90, 110 etc).
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  21. AVC Code:
    (eg 1720 0778)
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  22. MOD Registration:
    (eg 16 GX 60)
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  23. Contract Number:
    (eg LV2A/004)
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  24. Date of Manufacture/Date
    into Service:
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  25. Date Released from service:
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  26. Chassis Number:
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  27. Engine Type:
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  28. Known History or
    information of interest:
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  29. Cost:
    0.00 GBP


  30. 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?
  31. Publication consent*
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  32. Data protection
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  33. Confirm your human by answering the question below. Enter answer in lowercase.
  34. In EMLRA what does the M stand for?*
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  35.