Membership Application Form

Application Type *

Select one of the options from the dropdown menu

Membership Type *

Select one of the options from the dropdown menu

Name *

First Name Last Name

Member Number *

Please enter your club membership number.

Partner's Name *

First Name Last Name

Partner's Member Number *

Please enter your Partner's club membership number.

For renewing members, please provide the details below of all children you wish to include under your Family membership *

	Child Member's Full Name	Membership Number
Child #1
Child #2
Child #3

For new members, please provide the details below of all children you wish to include under your Family membership *

	Child Member's Full Name	Date of Birth
Child #1
Child #2
Child #3

Address: *

Street Address

Street Address Line 2

City/Suburb State

Post Code

Email

Home Phone:

Please enter your home phone number (if applicable).

Mobile:

Please enter your mobile phone number.

Please provide the details of your Chevrolet vehicle(s) below - if more than 3, please email the club with the additional vehicle details *

	Year	Body Style	Model	Series	Condition
Chev #1
Chev #2
Chev #3

1. I/we apply to become a member of the Vintage Chevrolet Association of Queensland Incorporated subject to its Rules of Association the obligations of which I/we accept.

2. I/we agree to pay the subscription for club membership for the time being in force. I am aware that my/our details provided above may be published in the Club Register which is restricted to club members only.

3. I/we undertake not to disclose or disseminate other member's personal details to non-members or organisations.

Member Acknowledgement *

I have read, understood, and accepted the rules for club membership.

Please verify that you are human *

Once you submit your application, we will contact you to complete your membership application and provide details on how to pay your annual club membership fee.

Thank you!

Club Membership Application Form

Conditions of Membership