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NEW MEMBERSHIP APPLICATION FORM

> Click here if you need to renew current membership

Personal Information:

First Name:

Surname:

Gender:

Male     Female    

Nationality:

Date of Birth:

Full Address & Postcode:

This is essential for sending out your membership pack!

Email Address:

Forum username:

Haven't registered on forum yet 

 

Car Details:

What car do you own?

 

Only UK Rallye owners need to complete the following questions - Please have your V5 logbook in front of you when filling in the form, incomplete forms will NOT be accepted and will just delay your membership application. Please note this information is essential for inputting your car details into the Rallye Register database and finding your import number. It is strictly confidential and in no way will be passed to any other 3rd party.

What Rallye do you own?

Series 1 1.3 8v      Series 2 1.6 8v   

Series 2 1.6 16v (non UK)      

Series 1 16v Conversion   

Series 2 16v Conversion

Exact date you acquired your Rallye: Please state DD/MM/YY. Date is found on logbook

Full Registration Number: Found on logbook

Exact date of first registration: Please state DD/MM/YY. Date is found on logbook

What colour is your Rallye?

Black      White    Red      Blue   

Other colour please state

Current Mileage:

Peugeot dealer who sold the car new? Only answer if you know for sure!

Don't know 

Chassis/VIN Number: Found on the logbook.

Engine Number: Found on the logbook.

How many previous owners? Found on the logbook.

Postcode your Rallye is currently registered to? Found on the logbook.

Postcode of previous owner? Found on the logbook. This is essential information needed to find your import number

Standard factory optional extras fitted when car was bought new. PAS applies to S2 Rallyes only. Sunroof available on S1 Rallyes only. Airbag in the steering wheel indicates the car has got PAS.

Power Assisted Steering (PAS)     

Factory Fitted Sunroof      

Modifications: Please give details of any modifications your Rallye has. You don't need to go into too much detail if you have lots!

 

Membership Status:

Membership level required.

1 year Rallye Register membership @ £22   

2 year Rallye Register membership @ £36   

3 year Rallye Register membership @ £45   

Payment Options. Please tick how you would like to pay for your membership

Cash or Cheque   

Credit or Debit card via PAYPAL   

Payment Information: To pay by cash or cheque, please print out this order form and send with your payment to 106 Rallye Register, 15 Hameldon Road, Rossendale, LANCS. BB4 8RL. If sending cash please send by registered post. If paying by cheque, make it payable to "106 Rallye Register"

To pay by credit card or debit card via PAYPAL our online payment system, please tick the PAYPAL option above and click submit where you will then be directed to our online payment page to complete your application.

Any questions regarding this form or payment please email webmaster@106rallye.co.uk

 

 

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