Club Membership Registration Form

New Membership Registration
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
E-mail
Occupation:
Code of Conduct
Please read our code of conduct. Please check the box if you agree to abide by these principles.

I agree
Date

MonthDayYear
Date
Signature

Clear
Payment
Direct Deposit:

Bank: Suncorp Bank
Account Name: Emerald Car Club
BSB: 484-799
Account No: 606310389

Cheque to: Emerald Car Club posted to the address above. The fee can also be paid in person to a member of the Committee.

Membership Costs:

New membership:
$80.00 per club year, (includes 1 Shirt)

$40.00 per club year thereafter.

Existing Member:
$40.00 per club year.

Please call Joanne (Secretary) for any further information- 0481 063 395
Once you submit your application, we will contact you shortly to complete your membership application. Thank you!
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New Membership Registration