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The adhesion form to the Swiss barchetta Club

Personal Data

   
The fields with * are OBLIGATORY !  
Last name * Name *

Date of birth *

. .

Profession

Address *

NPA *

City*

Country of residence *

 

Private phone *

Mobile phone

professional phone

Telefax

Private e-mail *

Public e-mail

 

Categories of member

 

Active member *

Partner of active member *

Member of support *

Contributions for the first year: Fr 75.- / € 52.-

Contributions for the first year: Fr 50.- / €34.-

Annual contributions: from Fr 100.- / € 68.-

 

About your car

 

Model

Color

Plates number

Frame number

1st putting in circulation

month, year

 
I request my adhesion from the barchetta Swiss Club and I confirm to have taken knowledge of the statutes.

 

   
 
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