CLUB BELGIUM

 Membership from end 2007 - 2008

  YEARLY FEE (reserved to Lamborghini owner)      125,- €
 

FILL IN & SIGN FORM AND RETURN IT WITH THE CHARTER*

 (the following informations will be kept as strictly confidential)

      I wish to join the Lamborghini Belgium as member :

      LAST NAME        ……………………………                FIRST NAME …………………………………             PHONE ……………………………

      ADDRESSE    ……………………………………………………………………………………………………………………………

                      ……………………………………………………………………………………………………………………………

      Job    …………………                                   GSM    ……………………

      Email address  ………………………………………………………

      Comment or additional information    …………………………………………………………………

      Lamborghini owned                   ……………………………………………………………………………………………

                                             (right model, year, VIN chassis number, colour, registration plate)

                                                    ……………………………………………………………………………………………

                                                    ……………………………………………………………………………………………
                                                 
 
     Fee : attached the following check of …………………   on behalf of Lamborghini Club Belgium.
      Or bank transfer of 125,- € done on the Dexia bank account
# 068-2485013-94
      Secretary:    
' +32 (0) 477 763 911
      Website www.lamborghiniclubbelgium.com 
      Email: info@lamborghiniclubbelgium.com



Club Belgium

 
AGENDA
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* The Charter needs to be asket at Secretary. Lamborghini Club Belgium keeps the right to accept or to decline any membership submission.

            Or         Download here the PDF here

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