UDRUGA POVIJESNE TEHNIČKE KULTURE
OLDTIMER CLUB CLASSIC – BJELOVAR
Bjelovar, Alojzija Stepinca 21, 091/5080-794
OIB 01430623073 , IBAN HR0424020061100555651
Osobna PRISTUPNICA ZA ČLANSTVO U KLUBU
Opći PODACI
IME I PREZIME :___________________________________________________________________________________________________
ULICA I KUĆNI BROJ : ___________________________________________________________________________________________
POŠTANSKI BROJ I MJESTO: ____________________________________________________________________________________
DATUM ROĐENJA: ______________________________________________________________________________________________
BROJ KUĆNOG TELEFONA : _______________________________________________________________________________________
BROJ MOBILNOG TELEFONA: _________________________________________________________________________________
E-MAIL : ________________________________________________________________________________________________
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.
U ______________________, _______________ 2016.g.
Potpis: ___________________________