Independent Union of Approved Driving Instructors

	Complete the following form to request membership to IUADI. Fields marked with a * are optional. Press the submit button when complete. Cheques should be made payable to IUADI and sent to: IUADI, 22 Albemarle Road, Norton, Stourbridge, West Midlands DY8 2BG FEES:- £10 per annum (To be reviewed annually.) If receipt is required please send an S.A.E.

First name:

Middle initials:

Last name:

Address line 1

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Town/City:

Post Code:

Telephone:

E-mail:

ADI No.

ADI expiry date:

Month / Year eg 08/58

Date of Birth:

Day Month Year 19 *

Car details:

Make *
Model * c.c. *
Petrol Diesel *
Expected change date Month *
Expected change date Year *
Will you change manufacturer Yes No *
If Yes, to which manufacturer *

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