Membership Application Form 2011/2012 Membership 1 July 2011 - 30 June 2012 - Cost $55 After completing this form you will be asked to pay by credit card using PayPal - IT IS NOT NECESSARY TO HAVE A PAYPAL ACCOUNT TO DO THIS Your online membership application is not complete until the online payment is processed. You cannot provide online details and pay offline Club Membership entitles you to participate in all Club activities, receive the Club magazine, use Club tools and spares and on the presentation of your Club membership card, receive discounts at specific motorcycle and accessory shops and various other businesses supporting us.
Your details will only be kept on file for Club use. I agree to my details being used by the Club for identification and mail-out purposes
Surname: *
Given name: *
Date of Birth:
Home Address: *
Suburb / Town: *
Postcode: *
State: *
Is your postal address the same as your home address?
Postal Address:
Suburb / Town:
Postcode:
State:
Home phone number:
Mobile phone number:
Email address: *
Your newsletter will be emailed to you unless you elect to receive it by post.
I wish to receive my newsletter by post only.
Anonymous List This is a service where members agree to assist or be contacted by other members. The only information published is Suburb/Town, Phone number, First name and Codes indicating service offered.
I wish to be included in the Anonymous List.
What services can you help with?
I acknowledge that by submitting this form and the appropriate fee, if accepted for membership of the Club, I agree to the above.
Model:
Year:
Registration Number:
