Membership Form

New Membership Application

First Name

Last Name

Phone

Address

Address (House, Street, Suburb, State, Postcode)

Are your Residential and Postal Addresses the same?

Yes

Residential Address

Address (House, Street, Suburb, State, Postcode)

Optional Information

We'd love to know a little more about you!

Optional Info

Please describe your Interests

Payment Information

Please provide the following details to allow us to determine your Fees for this Membership Application

I am applying for (tick one of the following 2 boxes)

1 Years membership (Fee is as specified below)

3 Years membership (3 times the 1 year fee + the Joining fee). This may be beneficial to you, particularly if you plan to have a vehicle on Historic Registration, as Logbooks have a 3 year life, so you would only need to get your logbook updated every 3 years rather than every year & the Logbooks for multiple vehicle owners would all expire at the same time.

Membership Number

I am applying for a NEW MEMBERSHIP, in one of the following membership categories (Tick the appropriate box). NEW Memberships attract a once-off fee equal to one half of the current Annual Fee. Renewals of Memberships which are still active (Financial) do not attract this fee.

FULL MEMBER ($245 for 3 years). Comprises $70 annual Membership (*3) + $35 Joining Fee

REMOTE MEMBER ($140 for 3 years). Comprises $40 annual Membership (*3) + $20 Joining Fee. Only available if residing more than 100 km from clubrooms (Subject to committee approval)

ASSOCIATE MEMBER ($140 for 3 years). Comprises $40 annual Membership (*3) + $20 Joining Fee. Only available to a Full Member’s Partner

JUNIOR MEMBER ($140 for 3 years). Comprises $40 annual Membership (*3) + $20 Joining Fee. If under 18 as at Jan 1 this year

FULL MEMBER ($105 for 1 year). Comprises $70 annual Membership + $35 Joining Fee

REMOTE MEMBER ($60 for 1 year). Comprises $40 annual Membership + $20 Joining Fee. Only available if residing more than 100 km from clubrooms (Subject to committee approval)

ASSOCIATE MEMBER ($60 for 1 year). Comprises $40 annual Membership + $20 Joining Fee. Only available to a Full Member’s Partner

JUNIOR MEMBER ($60 for 1 year). Comprises $40 annual Membership + $20 Joining Fee. If under 18 as at Jan 1 this year

If applying for Associate Membership, what is the name of the “Full Member”

Date of Birth

NB: The Clubs Membership year is from Jan 1 to Dec 31, however applications received between Oct 1 & Dec 31 will be granted membership until Dec 31 the following year (up to 15 months membership).

Also note that we store NO Credit Card or Paypal details. You will be taken directly to a secure Payment Gateway to complete your Payment

Total Payment Amount (to be charged to your Credit Card)

Pay with Card (Stripe)

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New Membership Application

Optional Information

Payment Information

Historic Registration?

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