ONLINE   INSCRIPTION FORM

 

I pay 33,00 Euro on account number 735-2072134-08 of the GOLD WING MOTOR CLUB BELGIUM  for a one year membership as driver. For my passenger I pay 12,00 Euro as membership fee. 
For two persons the fee is 45,00 Euro. 
Due to the fact that I'm not living in Belgium I have to pay 12,00 Euro extra for mailing the "Gold Wing Magazine" to my address.

After payment I have to wait 3 or 4 weeks before receiving my membership card and the first magazine.

GWEF "Help Guide"       In case of urgency I have :

Answer with yes or no

tools   camping   lodging   telephone   garage

Ik spreek volgende talen
Dutch   French   English   German

______________________________________________________

New Member          Renewal    

_______________________________________________________

* obligatory

Name and Christian name driver  *   

Street + n°    *                                     

Zipcode + Town + State* 

Country    *   

Telephone                Fax  

Date of birth dd/mm/yyyy*        Profession 

-------------------------------------------------------------------------------
Name and Christian name passenger *
-------------------------------------------------------------------------------

Year of Manufacture GW *      cc*   

Color

Frame n°       *  

License plate *  

Solo      Side-car      Trailer 

________________________________________________________________

email *