Name .................................  X1/9 Model .............................
                                          (eg Standard, Lido, VS, Gran Finale)
Address ..............................
                                        Size/Type of Engine ....................
......................................    (eg 1300, 1500, 1500 injection)

......................................  Colour(s) ..............................

......................................  Registration Number ....................

......................................  Registration Year ......................

Postcode .............................  Plaque number (1300s only) ............

Tel. Day .............................  How did you find out about the Club?

Tel. Evening .........................  ........................................
                                        (eg internet search/other site,
Email ................................   magazine (specify), previous owner)


Modifications/Additional X1/9 Information ......................................

................................................................................

................................................................................

The current annual membership fee is £30 sterling. Please note that we can only accept cheques, postal orders or
banks drafts with this application form.  You can pay via PayPal or credit card via the Online Reglia Shop.
Note that orders made via the online shop are subject to a £1.50 payment administration fee.

Forward this form together with a cheque, postal order or bank draft to the address below. Please telephone
if you have an application enquiry. An answer machine is available. Please make your cheque, postal order
or bank draft payable to the 'X1/9 Owners Club'.