Application form

Please complete the following details, print the form out (ensure it all prints out) and sign it, and send a cheque/postal order for GBP £12 (made payable to Dutton Owners Club) or Euros €20 cash to:

Sam Loynes, 20 Ridge Road, Middlestown, Wakefield, Yorkshire, WF4 4QW.

The membership subscription is for a year, and covers 'The Member' and up to two additional 'Family Members' living at the same address (see notes on previous page).

Please use capital letters throughout.

Main Member:

Mr Mrs Miss Ms Other
Surname: First Name/s:

Family Members:

Mr Mrs Miss Ms Other
Surname: First Name/s:

Mr Mrs Miss Ms Other
Surname: First Name/s:

Address:

Address:
Town: County:
Postcode: Country: Other (please specify)

Telephone: e-mail:

Vehicle details:

Please select the model and series number (see Identify your Dutton if unsure)

Model Phaeton Melos Sierra Sierra Drophead Sierra
Pickup 		Registration number:

Not registered:

B Type B Plus P1 Rico Rico
Shuttle 		Beneto Chassis no:
Malaga Malaga
B+		 Legerra Cantera Not sure Other: Engine make/type/cc:
Series number 1 2 3 4 Not sure Axle and gearbox:
Other details:
 
If you have any other Duttons that you would like to add, please write at the bottom of the page.




 

 

 

 

 

 

 

 

 

Confirmation:

I wish to join the Dutton Owners Club: ______________________________________________

Family members: _______________________________________________________________

All people wishing to join the club must sign above.

If you have previously been a member of the Dutton Owners Club, please indicate here:

Please print this form out, and send together with payment to the Membership Secretary (address at top of page). Your membership pack (including a windscreen sticker and copy of the latest club magazine) will be sent to you shortly, however, please bear in mind that the DOC is run by members in their spare time, so please be a little patient!