OLDTIMER CLUB CLASSIC – BJELOVAR

Bjelovar, Alojzija Stepinca 21, 099/555-0507, 091/5080-794

MB 2523582, OIB 01430623073, Žiro račun (Erste): 2402006-1100555651

OSOBNA PRISTUPNICA ZA ČLANSTVO U KLUBU

                Opći podaci

 IME I PREZIME:___________________________________________________________________________________________________________________________________________

 ULICA I KUĆNI BROJ: ____________________________________________________________________________________________________________________________________

 POŠTANSKI BROJ I MJESTO:_______________________________________________________________________________________________________________________________

 DATUM ROĐENJA: ______________________________________________________________________________________________________________________________________

 KUĆNI BROJ TELEFONA: ________________________________________________________________________________________________________________________________

 BROJ MOBILNOG TELEFONA: ____________________________________________________________________________________________________________________________

 E-MAIL ADRESA: _________________________________________________________________________________________________________________________________________

             Podaci o vozilu

VRSTA VOZILA: (osobno, teretno, motocikl, traktor itd...) ____________________________________________________________________________________________________

MARKA I TIP VOZILA: ____________________________________________________________________________________________________________________________________

MODEL: __________________________________________________________________________________________________________________________________________________

GODINA PROIZVODNJE: __________________________________________________________________________________________________________________________________

SNAGA MOTORA U kW: ___________________________________________________________________________________________________________________________________

BROJ ŠASIJE:______________________________________________________________________________________________________________________________________________

REGISTARSKA OZNAKA: __________________________________________________________________________________________________________________________________

Ovim dokumentom izražavam želju postati članom Oldtimer kluba Classic-Bjelovar,  te se pridržavati svih odredbi Statuta kluba, s kojima sam upoznat.

U ______________________, _______________ 2011.g.

                                                                                                                                                                         Potpis: ___________________________

www.classic-bjelovar.hr

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