Car Club Membership Form (2023)

Car Club Membership Form (2023)

SDCC is a Motorsport Australia affiliated car club

Member 1
Full Name of Member 1*

First NameLast Name
Were you under 18 yrs of age on 1/1/2023?*
Occupation/Business
Email 1*
example@example.com.au
Mobile Phone Number (or best contact no.)*
Please enter a valid phone number.
Motorsport Australia Licence/Member no.
Motorsport Australia Officials Licence Type & Grade (if known)
Eg Secretary/Rally/Steward/Scrutineer/Event Command/Timing & General/Bronze/Silver/Gold
Plastic Membership Card (only needed if competing)

Yes PleaseNo Thank you
Previous SDCC Membership Number (if known)

Member 2
Full Name of Member 2

First NameLast Name
Were you under 18 yrs of age on 1/1/2023?
Occupation/Business
Email
example@example.com.au
Mobile Phone Number (or best contact no.)
Please enter a valid phone number.
Motorsport Australia Licence/Member no.
Motorsport Australia Officials Licence Type & Grade (if known)
Eg Secretary/Rally/Steward/Scrutineer/Event Command/Timing & General/Bronze/Silver/Gold
Plastic Membership Card (only needed if competing)

Yes PleaseNo Thank you
Previous SDCC Membership Number (if known)

Member 3
Full Name of Member 3

First NameLast Name
Were you under 18 yrs of age on 1/1/2023?
Occupation/Business
Email
example@example.com.au
Mobile Phone Number (or best contact no.)
Optional
Motorsport Australia Licence/Member no.
Motorsport Australia Officials Licence Type & Grade (if known)
Eg Secretary/Rally/Steward/Scrutineer/Event Command/Timing & General/Bronze/Silver/Gold
Plastic Membership Card (only needed if competing)

Yes PleaseNo Thank you
Previous SDCC Membership Number (if known)

Member 4
Full Name of Member 4

First NameLast Name
Were you under 18 yrs of age on 1/1/2023?
Occupation/Business
Email
example@example.com.au
Mobile Phone Number (or best contact no.)
Optional
Motorsport Australia Licence/Member no.
Motorsport Australia Officials Licence Type & Grade (if known)
Eg Secretary/Rally/Steward/Scrutineer/Event Command/Timing & General/Bronze/Silver/Gold
Plastic Membership Card (only needed if competing)

Yes PleaseNo Thank you
Previous SDCC Membership Number (if known)

Payment details
Bank Details

Account Name: Southern Districts Car Club

BSB: 105-136

Account no: 510078640

Reference: "Membership_YourSurname"
Date EFT Payment made

DayMonthYear
This helps us find your transaction
A valid Motorsport Australia Licence is required to enable you to compete. This is available via the Motorsport Australia website https://www.motorsport.org.au/licence
If you have selected "Request Membership Card" above, your card will be posted, once the completed form is processed and payment has been confirmed.

To ensure delivery of your card for an event, please ensure your membership form and payment is completed no less than 2 weeks prior to your event 'document checking'.
Postal Address (for Card if req)

Street Address

Street Address Line 2

SuburbState

PostcodeCountry
Should be Empty: