Membership Application Form 2002-2003

Surname ........................................................ Forename .........................................................................(Mr/Mrs/Miss)

Address...............................................................................................................Town.................................................

County...................................................................................Country.........................Post Code...................................

Tel: .................................................................. e.mail .................................................................................................

Would you allow the Club to publish your details ie. Name, Tel., e-mail for members? (Yes/No)

Vehicle Type:(LWB/SWB/Tdi/Petrol) Engine:(2500/2600/2800/3000/3500) (delete where necessary)

Model: Pajero/Shogun Colour ................................................ Year: ......................

Caravanner? Yes/No Off-Roader? Yes/No

The vehicle is used mainly for: recreational/business/everyday transport/towing.
(delete whichever is not applicable)

Membership fee is £10.00 for UK/£20 for non-UK (to cover airmail postage) which is valid for 1 year or part thereof commencing 1st February each year.
You may also make a donation to cover Club funds should you wish.

Please print off the form and send together with your membership fee of £10/£20 and donation (if applicable) of £........... to the Club Secretary:
Mr Ray Waller, 'Mauray', 22 Nightingale Lane, Feltwell, Thetford, Norfolk. IP26 4AR.
(Please make cheques/Postal Orders payable to: The Mitsubishi Pajero & Shogun Owners Club.)

Revised 22nd December 2001