Registration Form

Name (required)
Street address (required)
Town/city (required)
Post Code (required)
Email (required)
Phone (required)
Alt Phone (required)
Occupation (required)
(NZ law for incorporated clubs & sociteties requires us to collect occupation information)

Vehicle Details:

Model Type Year Reg
I/we wish to apply for: Rate
 Individual ($40) Family Membership ($42) Country Membership ($35) Family Membership ($37)

Half rates apply if joining between 1st Jan & 30th June. Payments can accepted by cheque or by electronic transfer. (Account details will be sent on receipt on membership application)

I would like to receive newsletters by:

Privacy Policy : Personal information supplied to the Peugeot Car Club (Wellington) Inc will be securely held by the club for administrative purposes and not divulged to third parties without your consent. Personal information held is available for inspection and correction.

 I agree to pay the annual membership fee listed above