Please complete the text boxes and tick boxes where applicable and then print this form

Title  Age (if applying for Senior Citizen or Junior rate)

First name

Surname

Address 

Town County

Postcode  Country

Telephone number(s)

E-mail address

Do you own a bus or coach? Yes No                                          If yes, please give details below.

(Include registration, chassis, body and other relevant details)

How did you find out about the group?

Please enrol me as a member of the Leyland National Group: (Tick box)

* Join for 5 years and get a 10% discount!

(Prices shown for 5 years membership include the 10% discount)

Overseas Membership (all countries except UK)

To cover additional postage costs, please add the following to the Membership rates shown above: (Tick box)

Enclosed is my subscription payable by:           Cash           Cheque   Postal Order

Please make Cheques / Postal Orders payable to ‘Leyland National Group’.

Do not send cash by post, we cannot accept responsibility for cash sent by post.

Please remit in £ Sterling. Live outside the UK? Most banks should be able to write you a cheque in Pounds Sterling. Alternatively you can pay using 'Western Union Money Transfer' (see www.westernunion.com for details). If you wish to pay using 'Western Union Money Transfer' please contact the Membership Secretary for further details by clicking here.

Signature _________________________________________________ Date _________________________

Data Protection: Certain information will be stored on an electronic database, but will not be released to unauthorised persons or to any person or organisation outside the Leyland National Group.

© Leyland National Group 2007. (LNG Website membership form)

Please complete, print out and post this form with your remittance to:

Tim Wild, Membership Secretary, Leyland National Group,

27 Dukeshill Road, Bracknell, RG42 2DU, England