CCOCA NEW MEMBER APPLICATION

CCOCA MEMBERSHIP APPLICATION

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Fee Details
- Membership Fee is $35 for 12 months from joining anniversary date.
- Membership includes soft copies of Front Drive
- Partner or a Family member, Membership is FREE .
- Printed copies of Front Drive (x6) are an extra $45 posted to an Australian address. They are not included in the Membership Fee and will need to be purchased as an optional separate item.
Complete Form and continue to Payment

Partners or a Family member are very welcome to become members.
Applicant Name *
Applicant Postal Address *

Country
Applicant Contact Details:
Email *

Confirmation Email
Mobile Number
Mobile
A/H Phone Number
Partner or a Family Member Name (if applicable and wanting to become a member of CCOCA)
Contact Details if different from Applicant contact details.
Partner or Family Member E-mail

Confirmation Email
Partner or F Member Mobile
Mobile
Partner or F Member A/H Ph Number
Applicant Occupation Past or Present *
eg Accountant, Engineer, Artist, Teacher, Retired Manager
Partner or Family Member Occupation Past or Present
eg Accountant, Engineer, Artist, Teacher, Retired Manager
Applicant. Decade in which you were born. *

1920 - 1929 1930 - 1939 1940 - 1949 1950 - 1959 1960 - 1969 1970 - 1979 1980 - 1989 1990 - 1999 2000 - 2009 2010 - 2019
Applicant Vehicle details. eg Model,Year, Colour, Reg No.
Applicant. Are you willing to help with activities? *
Yes or No or any other information
Partner or Family Member. Are you willing to help with activities?
Yes or No or any other information
Club’s Rules of Association Club's Privacy Policy.
I agree to be bound by the Club’s Rules of Association and I have read the Club's Privacy Policy. I understand that the Citroën Classic Owners Club of Australia Inc. accepts no responsibility for any injury to a member or guest attending an event or for any damage to personal property (including motor vehicles).
Applicant Confirm *

Confirm being bound by Club's Rules of Association and reading Club's Privacy Policy
Partner or Family Member Confirm

Confirm being bound by Club's Rules of Association and reading Club's Privacy Policy
Select Purchases *
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CCOCA Membership. Includes Free Partner or Family member Membership and Soft copies of the Club Magazine Front Drive $ 2.00 AUD

x 6 Printed Front Drives posted to an Australian address and which are not included in the Membership Fee $ 45.00 AUD
Optional

Total $ 0.00 AUD
New applications require Committee approval. New applicants are informed of the Committee's decision after the next designated monthly Committee Meeting and unsuccessful applicant's monies will be refunded.
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CCOCA MEMBERSHIP APPLICATION