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: ___________________________

 

www.classic-bjelovar.hr

classic.bjelovar @ gmail.com