www.fiat500club.org.uk FIAT 500 Club Membership application form. To join us in the FIAT 500 Club (UK) please complete the form below, then send along with your payment, either cheque (UK bank) or postal order made payable to Fiat 500 Club to our membership secretary. Janet Westcott, FIAT 500 Club, PO BOX 798, Aylesbury, Buckinghamshire, HP22 9DL About yourself: Name. Address. Tel. No. Email address. Occupation. About your car: Model Reg No, Year of manufacture. Engine No. Capacity (cc). Chassis No. Colour. Please list any interesting history your car may have on a separate sheet. Please list any interesting modifications to the standard specifications, that your car may have a separate sheet. History. Modifications. How did you find out about the club. For UK residents only: Please tick if Data Protection Act you do NOT wish to have your details Neer your dts wit be nel on comps Wit he lu wil under no ckeumatances held on computer. aaa Subscription details. enclose subscription for: full membership @ £20 per year junior membership @ £15 per year Associate membership @ £6 per year ‘Sy one copy oS Nene