Membership Application Form

Application Type*

Select one of the options from the drop-down menu

Membership Type*

Select one of the options from the drop-down menu

Name*

First NameLast Name

Partner's Name*

First NameLast Name

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

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

Address:*

Street Address

Street Address Line 2

City/SuburbState

Post Code

Email

Home Phone:

Please enter your home phone number (if applicable).Format: (00) 0000 0000.

Mobile:

Please enter your mobile phone number.Format: 0000 000 000.

Please provide the details of your Chevrolet vehicle(s) below - if more than 5, please email the club with the additional vehicle details*

Rows	Year	Body Style	Model	Series	Condition
Chev #1
Chev #2
Chev #3
Chev #4
Chev #5

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/we am/are aware that my/our details provided above may be published in the Club Register which is restricted to club members only.

Please pay sub to: VCAQInc. @ Bendigo Bank BSB 633-000 Account 197205255
advising your Member Number & eMail the form (see above) OR post form & your payment
to P.O. Box 20 Holland Park QLD 4121

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

I/we 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