Académique Documents
Professionnel Documents
Culture Documents
Rev. : 1a
Revision Date : 10/2/2008
Effective Date : 10/2/2008
Pls attach 1x1 ID photo on this side
Club website:
Look for Local Chapters/Cebu Chapter Sub-board
Car Club Membership Form
Family Name: Date:
First Name: Nickname: Forum Username:
Middle name Birthdate:
LTO License No. Birthplace:
Complete Address:
Zip Code:
Email Address:
Home Tel. Number: Mobile Number:
Office Address:
Office Tel. No.: Office/Home Fax No.:
Occupation: In the field of:
Business (if any):
Skills/Expertise:
If a member has a car problem near you can you offer Roadside Help/Assistance?
Please check:
Yes No
If YES, when wouldn't you mind being contacted:
Days Evenings Nights Weekends Past 12MN or early morning
Please provide youre preferred contact number for this purpose:
In case of emergency please notify the following contact persons below: Name & contact no.
The undersigned is a bonafide member of the Kia Pride Club Cebu Chapter and entitled to all rights and
privileges due to a member.
Signature over Printed Name