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Membership Renewal Form
Membership 1 July 2011 - 30 June 2012 - Cost $50 until 31st August, $55 after 1st September
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 renewal 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.
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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
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Yes
No
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Please complete the form and select the submit button when done.
The items marked with * are required fields.
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Surname: *
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Given name: *
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Date of Birth:
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dd
mm
yyyy
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Home Address: *
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Suburb / Town: *
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Postcode: *
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State: *
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Is your postal address the same as your home address?
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Yes
No
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Postal Address:
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Suburb / Town:
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Postcode:
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State:
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Home phone number:
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Mobile phone number:
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Email address: *
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Your newsletter will be emailed to you unless you elect to receive it by post.
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I wish to receive my newsletter by post only.
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Yes
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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.
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I wish to be included in the Anonymous List.
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Yes
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What services can you help with?
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Bed / Accomodation
Camping Space
Mechanical Assistance
Transport Assistance
I am prepared to travel (kms) to provide help
I am prepared to welcome social vists
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Whilst I remain a member of the BMW Motorcycle Club of WA Inc., I hereby agree that I will
abide by the Club Constitution and By-Laws and declare that I shall take full responsibility
for my own actions and indemnify the Club, the Committee and Fellow Members for any and all
injuries and / or damage I may sustain to myself and my property whilst participating in Club
activities.
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I acknowledge that by submitting this form and the appropriate fee, if accepted
for membership of the Club, I agree to the above.
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Yes
No
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Motorcycle Details
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BMW Motorcycle 1
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Model:
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Year:
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Registration Number:
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BMW Motorcycle 2
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Model:
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Year:
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Registration Number:
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BMW Motorcycle 3
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Model:
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Year:
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Registration Number:
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BMW Motorcycle 4
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Model:
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Year:
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Registration Number:
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