LCCT Membership Form

Join the Light Car Club of Tasmania today!
MEMEBERSHIP BENEFITS

Monthly LCCT social club nights, special functionsconducted throughout the year by the Club and others, invitations to clubsporting events conducted by LCCT and other clubs, regular contact through theClub website at http://www.lcct.com.au and the Club FacebookPage https://www.facebook.com/LightCarClubOfTasmania
MEMBERSHIP FEE (expires 31 Dec current year)

Single $60 Family $80 (you, your partner and all children under 18 years of age)
Membership type?*

SingleFamily
Membership Number
Members Name*

First NameLast Name
Address*

Postal Address

Postal Address Line 2

CityState

Post Code
Mobile*
Email
example@example.com
Civil Licence

Licence NoExpiry Date
MA Licence

Licence NoExpiry Date
Partners Name

First NameLast Name
Mobile*
Email
example@example.com
Civil Licence

Licence NoExpiry Date
MA Licence

Licence NoExpiry Date
Add a child to the Family Membership?

Yes
Child 1

First NameLast Name
Child 1 Birth Date

DayMonthYear
Add another child to the Family Membership?

Yes
Child 2

First NameLast Name
Child 2 Birth Date

DayMonthYear
Add another child to the Family Membership?

Yes
Child 3

First NameLast Name
Child 3 Birth Date

DayMonthYear
Add another child to the Family Membership?

Yes
Child 4

First NameLast Name
Child 4 Birth Date

DayMonthYear
I agree that, when elected, I will abide by the rules of the Club at all times.
Applicants Signature*

Clear
Security Check*
Payment via?*

EFTSquare / Credit Card
Payment Via EFT;

BSB: 087 728

ACC: 51615 2785

Account Name: The Light Car Club of Tasmania

*please use surname as the reference

Should be Empty:

Join the Light Car Club of Tasmania today!

MEMEBERSHIP BENEFITS

MEMBERSHIP FEE (expires 31 Dec current year)

Credit Card