Membership Application

Surname: *

First Name: *

Middle Initial:

Date of Birth: *

Sex: *

Email: *

Club News will be sent by fax or e-mail, so ensure that you have a contact to either of these.

Address: *

Address 1:

Address 2:

Parish: *

Home Tel:

Office Tel:

Fax:

Cell:

Competition Car - For Drivers

Make:

Model:

Year:

Engine #:

Chassis #:

Capacity: cc

Group:

Class:

Sponsors:

License Number:

Details of car most driven by applicant

A-Make:

A-Model:

Colour:

Driver:

License #:

Blood Type: *

Membership Status: *

Have you ever been convicted of a traffic offense within last three years?: *

Details of conviction:

Have you had any accidents involving insurance claims or injury to persons within the last five years?: *

Details of accident:

I agree to abide by the rules of the Barbados Rally Club: *

Agree

Type of Application: *

Proposed by: *

(name of existing member proposing for you)

Seconded by: *

CAPTCHA

This question is for testing whether you are a human visitor and to prevent automated spam submissions.

Downloads

BRC Membership Form

BRC_Membership_App_Form.pdf 547.52 KB