APPLICATION FOR MEMBERSHIP

First & Last Name*

Name of Spouse

Date of Birth*

Street*

Postal Code, City*

Country*

Phone*

Mobile Phone*

Email Address*

Instagram or Homepage

I agree to the sharing of my address data with club members* I agree to the sharing of my address data with club members* Yes No

I agree to the sharing of my address data with Daimler AG for the dispatch of the MB Classic Magazine and the MB ClubCard* I agree to the sharing of my address data with Daimler AG for the dispatch of 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 for Direct Debit Collection* Authorization for Direct Debit Collection* I hereby apply for membership in the Mercedes-Benz SLS AMG Club e.V. and fully acknowledge the statutes* in their entirety. I authorize you to collect the one-time admission fee of EUR 100 and the respective annual membership fee, currently EUR 120, from my account by direct debit. (The statutes can be requested at info@sls-club.de)

Name of Bank*

IBAN*

BIC*