Email  Password

Main | Articles | Calendar | Photos | Members | BulletinBoard

Article Show

LANDROVER OWNERS MALAYSIA CLUB 

By Alyna Tai 
Be part of LROM - Membership Application is open to all 4x4 Enthusiast.

Please filled up the form and fax to 03 613 80198 or email to Alynatai@gmail.com

Registration fees RM50.00 and annual membership RM60.00.
Lrom collect annual fees yearly on January so those who join now will only renew in 2011 January.

MEMBERSHIP APLLICATION FORM

Personal Details:
Name as in IC or Passport Gender:
IC/Passpost Number: Country of Origin:
Date of Birth: Blood Type:
Nationality: T.Shirt Size:

CONTACT DETAILS:
Correspondence Address:………………………………………………………..
…………………………………………………………
Postcode:…………………………..Town………………………
State:……………………………….Country…………………….
Contact Tel No: …………………………………… Fax: …………………………...
Mobile No: …………………………….Email Add: …………………………………...
Web page (if available):…………………………………

EMERGENCY CONTACT:
Name:…………………………………………………Relationship:………………………
Contact No:……………………………………………

VEHICLE DETAILS:
Make: ………………………Model:……………………..
Registration No:……………………Vehicle Nickname(if any):…………………………..

APPLICATION ENDORSEMENT
2 existing members must propose and second each application. Please leave blank if you do not know any members to be your partner.

NAME AND SIGATURE OF PROPOSER:
SECONDED BY:

The membership fee of RM110.00 for the first year (RM60 thereafter on every January) will be payable UPON APPROVAL of your application.

INDEMNITY : I hereby agrees to abide by the Rules and Regulations of the Club. I understand that as a member I will not hold the Club or any of it’s committee members liable for any mishap that may occur to the thoughout the duration of any activity held by the club.

THE CLUB COMMITTEE RESERVES THE RIGHT TO REFUSE ANY APPLICATION WITHOUT FURNISHING ANY REASON WHATSOEVER.

SIGNATURE OF APPLICANTS


…………………………………..
Date

Kindly attaché a passport photo digital photo for record purposes.