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First & Last Name*

Name of Spouse

Date of Birth

Street

Postal Code, City

Country

Phone

Mobile

Email Address*

Instagram or Homepage

I agree to the transfer of my address data to the club members I agree to the transfer of my address data to the club members Yes No

I agree to the transfer of my address data to Daimler AG for sending the MB-Classic magazine and the MB-ClubCard I agree to the transfer of my address data to Daimler AG for sending the MB-Classic magazine and the MB-ClubCard Yes No

Details of your Mercedes-Benz SLS-AMG (W197) Details of your Mercedes-Benz SLS-AMG (W197) Convertible/Roadster Coupé/Gullwing SLS AMG GT3 I don't have an SLS-AMG yet

First Registration

Owned Since

Original Condition Original Condition Yes No

Vehicle Identification Number VIN

Paint Color

Interior Color

Extras Extras B&O Sound Ceramic Brakes Carbon Other (Please enter below)

Other

License Plate

Authorization to collect payments by direct debit Authorization to collect payments by direct debit I authorize the SLS-Club Deutschland e.V. to collect the respective annual fee of currently 120 euros from my account by direct debit. (*The statutes can be requested at info@sls-club.de)

Name of Bank

IBAN

BIC