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Membership Application Form

I would like to join the Jenny & Mark Pitman Racing Club. I understand that this membership will be for a full 12 month period from the date of this application (please allow up to 5 working days for your membership to be processed).

I would like to purchase a 12 month Membership as a Gift and would like you to send me a Gift Certificate (please complete the information below with the details of whom you are gifting this to).

Pay Now

Please use the buttons below to pay instantly through PayPal

or print and post this form to us with your credit/debit card details

or send a cheque made payable to "Jenny & Mark Pitman Racing Club"

I enclose full payment for annual membership of £195
Add your partner for £50 per year

On the expiry of my annual membership, I will be invited to renew this membership and I understand that it will be my choice to renew.  I am over 18 years of age.

__________________________________________________________________Signature (if returning by post)

Method of payment 

We accept cheques (payable to Jenny & Mark Pitman Racing Club), credit/debit cards, postal orders, cash (by registered mail). Please complete your details here:

Credit Card (we do not accept Amex or Diners Club)            

Card No:_______________________________________________________________

Expiry Date: _______________ Authorisation Code: __________(last 3 digits)

Signature: ______________________________________  Issue No:____________

Your information or the details of the person to whom you are gifting this to:         

Your name: ___________________________________________________________________

Name on Certificate (if applicable): ____________________________________________

Your address: _________________________________________________________________

_______________________________________________________________________________

__________________________________________  Postcode: __________________________

Email Address: ____________________________ Tel No: ____________________________

(I was introduced by: _________________________________________________)

Please post to:

Jenny & Mark Pitman Racing Club, Horsehay Farm, Duns Tew Road, Middle Barton, Oxfordshire OX7 7DQ, England