For official use only:    Membership Number……………….      Regional Group …………..
APPLICATION FORM FOR MEMBERSHIP
FIRST NAME  ……………………………………………………….
SURNAME  ………………………………………………………….
ADDRESS  …………………………………………………………..
………………………………………………………………..….
POST CODE  …………….……  TELEPHONE NO  ………………………………  EMAIL  ………………………...
I apply for membership of The Wolseley Register and I enclose the appropriate remittance of £12.50 /£25.00 / £70* (*delete as appropriate).  [Please make cheques payable to 'The Wolseley Register'].  SEE NOTE 1
I agree to be bound by the Constitution of The Wolseley Register, and understand that my membership is subject to approval by the Management Committee.
SIGNED ……………………………………………………….  DATE ……………….
-------------------------------------------------------------------------------------------------------------------------------------------------------------- VEHICLE REGISTRATION  SEE NOTE 2
Registration Number ……………………………………………..
Model of Wolseley …………………………….….
Date and place of first Registration ………………………………………………………………………………………………….. Country of first registration, if NOT UK ……………………………………………
If the current Registration Number is not the original please quote the original if you know it …………………………………….. Car/Chassis Number ………………………………………………….  (Pre 1936 m odels will have two numbers)
Engine Number (original) …………………………………….… Current engine, if different ……………………………………..
Commission Number (only used from 1965 to 1968) or Body Number …………………………………………………………….. Type of body…………………………
register for
If non-standard body please give name of coachbuilder ………………………………………
Colour Body paintwork (original) ……………………….…….      Body paintwork (current, if different) ………………………
Interior upholstery/trim …………………………………………….
Please list any details of special interest, such as original or non-original equipment, modifications, or a summary of any history.………………………………………………………………………………………………………………………………………………………………………………………………………………………………….. Current condition  ……………………………………………….
If recently purchased, give name and address of previous owner  …………………………………………………………………. PLEASE RETURN TO Cindy Shilton, Wolseley House, 1 Priory Crescent, Roade, Northamptonshire. NN7 2NF
NOTES
Please list details of other Wolseleys owned on the reverse of this form.
Subscription rates are as follows:
Join Membership runs to Cost
between 1 January and 30 June in any year 31 December of same year £25.00
between 1 July and 31 September in any year 31 December of same year £12.50
between 1 October and 31 December in any year 31 December of next year  £25.00
Three years’ membership – discounted rate (includes 10% Regalia voucher) £70.00
Overseas Applicants:  PLEASE PAY IN STERLING.
WOLSELEY REGISTER PAYMENTS BY CARD
For payment by credit or debit card, we are now able to process any of the following: Mastercard, Maestro, Visa,
Visa Electron, Solo and JCB
MINIMUM TRANSACTION AMOUNT £10 inclusive of any processing charges
ALL Transactions : there is a processing charge of £3.00
INFORMATION REQUIRED:
CARD TYPE:
NAME AS APPEARS ON CARD:
ADDRESS  OF CARDHOLDER:
POSTCODE:
SIXTEEN DIGIT CARD NUMBER:
THREE DIGIT SECURITY NUMBER:
START DATE OF CARD:
EXPIRY DATE OF CARD:
Information may be posted or preferably, faxed.  PLEASE NOTE the Register does not currently have a secure
site, therefore to minimise risk it is wise to send details split over multiple messages if this option is chosen.
Post to: Cindy Shilton, Wolseley House, 1 Priory Crescent, Roade, Northamptonshire, NN7 2NF England
Email: uk
Fax: +44(0)113 262 3610
1  Vehicle Registration Details
It is essential that all the relevant sections are completed. Without full details, registration of your car cannot be made and the Register will be incomplete. Please look for the chassis and engine numbers on the car rather than quote from the Vehicle Registration document.  Please quote all numbers in full with any letter prefixes or suffixes.
2  Data protection and the publication of information
The information we hold about you (name, address, telephone number, e-mail address, and the cars you own) will be handled and stored responsibly in line with the requirements of the Data Protection Act.
The Wolseley Register maintains a Membership List which contains the information its members have provided about themselves and their cars (as detailed above) and this List is published for the benefit of all members of the Register.  The list will only be published in paper form.
It is a condition of membership of the Wolseley Register that you agree to the publication of your information in the Membership List. However, we recognise that some people will not want to have their phone number or email address published.  If you wish to withhold this information, please tick the relevant boxes, below.
Please do not include my telephone number in the Membership List
Please do not include my e-mail address in the Membership List

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