Membership Registration

Membership Type*

Membership includes access to Vintage racing

Membership Duration*

Full Year (Jan-Dec)Half Year (Jan-Jun) or (Jul-Dec)

Status*

New MemberRenewing Member

Name*

First NameLast Name

Date of Birth*

Date

Email*

Have your details changed?

We require up-to-date details for the member register.

Mobile Phone

Please enter a valid phone number.

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Occupation

Any trade skills or profession that may assist the club.

Additional adult member?

Additional Adult Name

First NameLast Name

How many junior members?

Must be aged 16 & under

Junior Member 1 Name

Junior Member 1 DOB

Junior Member 2 Name

Junior Member 2 DOB

Junior Member 3 Name

Junior Member 3 DOB

Single Fee

Family Fee

Junior Fee

HY Discount

FEE SUB TOTAL

Promo Discount

MEMBERSHIP FEE $

How to Pay

Online with PayPal or CardDirect DepositPay Cash

If paying by cash, please visit race control at our next race meet to make payment. Memberships are not active until payment received.

Direct Deposit Details

BSB: 014-274

Account: 30-687-1239

Name: Chargers RC

Memberships are not active until payment received.

TOTAL MEMBERSHIP FEE

AUD

Payment Methods

Debit or Credit Card

Please click one of the PayPal options to complete payment and submit the form.