Club Membership Registration Form

New Membership Registration
Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State / 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

Month Day Year
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) – Please message Joanne on 0481 063 395 when you are ready to get your shirt and we can advise Emerald Industrial Supplies on Hospital Road that you are coming in to get your shirt ordered.

$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