Title: *

First Name:

Surname: *

Address (incl postcode): *

Phone - Home: *

Phone - Work:

Phone - Mobile:

Email Address: *

Driving Licence Expiry Date: *

Date of Birth: ...

Payment Fee: Please select current month Free membership for under 25 year olds January - £18.00 February - £16.75 March - £15.50 April - £14.25 May - £13.00 June - £11.75 July - £10.50 August - £9.25 September - £8.00 October - £6.75 November - £5.50 December - £4.25 *

Have you passed your RoSPA Test?
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ASSOCIATE MEMBERSHIP

I wish to become an Associate Member of the group and to train for the RoSPA advanced driving test.
Please fill in the details about the car that you will be training in below:

Make:

Model:

Engine size:

Gearbox type:

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FULL MEMBERSHIP (for those who have passed a RoSPA advanced driving test in a car)

I wish to become a full member of the group. I am currently a member of the national RoADA.

Date of last test: ...

Grade (B/S/G):

RoSPA number:

For GOLD grade holders - I would be interested in becoming a tutor:

I will send a cheque payable to RoSPA ADA SUSSEX for:

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