Kent RoSPA Advanced Drivers and Riders - Membership Application

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Kent RoSPA Advanced Drivers and Riders

Please complete either the Associate or Full Membership area as applicable. Full membership applies to those who have passed a RoSPA Advanced Driving Test and are currently members of national RoADAR.

Associate Membership

I wish to become an Associate Member of the Group, and to train for the RoSPA Advanced Driving Test.
The vehicle on which I will be training is:

Manufacturer: ________________________________ Model: ______________________________________

Engine cc: _______________________ Manual/Automatic: ______________________________

Approximate annual mileage: _______________________

Full Membership

I wish to become a Full Member of the Group. I have passed the RoSPA Advanced Driving Test within the last three years.

Date of last test: _____________________ Grade: __________________ RoSPA No: __________________

Please note that the above information must be given for Full Membership

For Silver and Gold Grade holders I would be interested in becoming an approved Tutor (yes/no): ______

Title: _______ First name: _________________________ Surname: ______________________________

Address: _________________________________________________________

_______________________________________________

_______________________________________________

_____________________________________________

Post Code: ______________

Occupation: __________________________________ E-Mail: ________________________________________

Home Phone: _________________ Work Phone: _____________________ Mobile: _____________________

Driving Licence expiry: ________________________

I enclose a cheque payable to "R.o.S.P.A Ass. (Kent Group)" for £22

Signed _________________________ Date: ________________

Please return this form to:
Mrs Lin Brooks, Membership Secretary, Kirbygate, Lower Warren, Bluebell Hill, Kent, ME20 7EH

Data Protection Act

Your membership details will be stored on computer for Kent Group use only, and will not be divulged to any other organisation.