IMOKILLY MOTOR CLUB
2019 Membership Application Form
Name: ________________________
Address: ______________________
Home Phone: ________________
Mobile: _____________________
Email:______________________
(Print clearly)
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_____________________________
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Membership Fee – Competition Licence Holder (requiring a stamp)
- Non Competition Licence Holder (no stamp required)
€30
€10
Notes. A club member who does not require a stamp on a competition licence application form but subsequently during the year seeks a stamp, will be required to pay the additional fee.  Club members will be automatically registered in both the club championship and the marshal championship. Club members are reminded that in order to be classified in club championships, they must comply with the regulations of the Club Championship. Members are notified of meetings and other club activities by text message.

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I hereby undertake as a condition of my membership of Imokilly Motor Club Ltd, to be of good conduct and not to bring the Club into disrepute, whether while engaged in the activities of the Club or otherwise, and to be bound by the International Sporting Code of the FIA, the Code of Conduct of Imokilly Motor Club Ltd, the memorandum and articles of association of the club, its bylaws and any such rules and regulations as to conduct generally as may be adopted, from time to time, by the Club.
Signed: _______________________________
Please return membership form plus appropriate fee to
Finbarr Fogarty
19 Old Cork Road
Midleton
Co. Cork.    Tel 086-3963523

Date: ___________________
For Official Use Only
Membership No. ________Date Received __________
Paid €________
Sign ________________
(Membership Officer