ONLINE MEMBERSHIP APPLICATION

If you want to affiliate as Club and you are the legal representative/president of the Club, please go to the club affiliation form.

First Name *

Middle Name

Last Name *

Adult *

I'm over 18Check this box if you're an adult (+18)

Date of Birth *

Day

Month

Year

Birthplace *

Nationality *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Country *

Tax ID *

ID Document Type *

ID Document Number *

Email *This will be your User ID

Phone *This is where you will receive the digital card

Password *

Confirm Password *

Are you a paying subscriber on YouTube or Instagram CUPRADRIVE account? (+6 Months) *YesNo

Your name on YouTube or Instagram *

I apply for the following membership tier: *CUPRISTA (€25/year) [€26.24 incl. PayPal fee]CUPRISTA VELOZ (€50/year) [€52.12 incl. PayPal fee]

I apply for the following membership tier: *CUPRISTA (€20/year) [€21.07 incl. PayPal fee]CUPRISTA VELOZ (€45/year) [€46.95 incl. PayPal fee]

I confirm that: *

• I have read and agree with the statute of the association
• I commit to the payment of the yearly social fee
• I give permission to the use of my personal data for the scope of membership of the Association and according to our privacy policy

Payment method: *I pay now via Credit Card [fees apply]I pay now via PayPal [fees apply]I have already paid via bank transfer and I attach a copy of the paymentSelect if you want to pay now, or if you have already paid

Upload copy of bank transfer:

No file chosen

Max size 10 MB

Total Amount

€

Credit / Debit Card *

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Disclaimer
This website is not associated to any official CUPRA brand. Its use has a recreational purpose.