Have you read the Terms and Conditions of the Membership Form (V6.1) prior to completing this form? * Which Car Club would you like to join? * Amman (SA18 1NB) Chepstow (NP16 1AA) Dinefwr (SA20 0AW) Kilgetty (SA68 0YA) Llandod (LD1 5DY)
Please note - you'll be able to book cars from any of these Car Clubs, but this Car Club will be your main contact point. Check with your local Coordinator first before booking cars from other locations as they can only be returned back to the local Car Club.
Occupation * Full address (House number, street, town, city and postcode) * Landline number Mobile number * Email * Driving licence number * Driving licence type * Full Provisional European/European Economic Area Other Have you ever had any insurance refused, cancelled declared void (as though it never existed), renewal declined, or special conditions imposed by the insurer? * In the last 5 years have you had any County Court Judgements (CCJs) made against you? * Have you ever had any form of bankruptcy or statutory insolvency proceedings? * Have you had any non-motoring criminal offences including convictions and charges not yet tried? * In the last 5 years have you had any motoring accident or loss or made any motor insurance claim, including personal injury? * Have you been issued with a fixed penalty notice or been convicted of, or received a police caution for, any motoring offence? * Have you ever had any driving convictions? * If you answered "yes" to any of the above, please provide: Conviction Code, Points received, Amount of fine paid, Length of ban (if applicable), Blood alcohol reading (if applicable) and Length of custodial sentence (if applicable)? Do you suffer from any of the below conditions, which are notifiable to the DVLA? * If you answered "yes" to any of the above, please give further details and whether or not DVLA have been notified Please confirm that your membership will be a Trial Membership for the first 12 months, before you can have Full Membership (Full details available on the Terms and Conditions). * Do you require a Family Membership? * If answered "yes" above, please add in the names below of who will be sharing your Family Membership (Up to 3 others only, max of 4 can share a Family Membership) Do you agree to the Terms and Conditions and declare that you are fit, legally able to drive and everything you have written is true and correct? Do you agree toll notify TrydaNi – Charge Place Wales Ltd. in writing of any changes to the above information as soon as is possible? *