Riley Club Membership Application Form

Riley Motor Club Qld Inc

Membership Application
Thank you for your interest in the Club. Please enter your details below and click submit. You may provide payment by either:

1. crossed cheque to Riley Motor Club Qld Inc,

2. providing evidence via website store of direct payment to our Bendigo Bank account BSB 633000, Account Number 156635229, your name as reference,

3. or via the website PayPal/credit card option.

Annual Membership Fee $50

Family Membership Fee $75 (includes 3 extra family members)

The Membership Fee is due and payable on 1 January each year and covers the calendar year. Members joining after 1 October have membership until 31 December of the following year. Membership lapses if fees are not paid by the last day of February in any year.
Application for membership
Type of Membership*

Individual MembershipFamily Membership (Total of 4 members)
Name*

First NameLast Name
Mobile Number*
Please enter a valid phone number or landline inc area code
Email*
example@example.com or 'No email'
Address*

Street Address

SuburbState

Postal Code
Name of 1st extra family member, normally your spouse/partner (if applicable)

First NameLast Name
Address of 1st extra family member (if different to above)

Street Address

Street Address Line 2

SuburbState

Postal Code
Name of 2nd extra family member, normally a child under 18 (if applicable)

First NameLast Name
Name of 3rd extra family member, normally a child under 18 (if applicable)

First NameLast Name
Number of vehicles to be registered with the Riley Club Qld*

OneTwoThreeFour or more
Details for Vehicle register*
Please upload a photo of your vehicle (optional)

Cancelof
Details for Vehicle register (2nd vehicle if applicable)
Please upload a photo of your 2nd vehicle (optional)

Cancelof
Details for Vehicle register (3rd vehicle if applicable)
Please upload a photo of your 3rd vehicle (optional)

Cancelof
Details for Vehicle register (4th vehicle if applicable)
Please upload a photo of your 4th vehicle (optional)

Cancelof
Note: Your Newsletter (TorqueTube) will be sent by email. Tick if unable to receive email

Unable to receive emails
Membership items*
prevnext( X )
New Membership
$50.00AUD

Family membershipIncludes your membership plus a spouse, partner or children (up to 3 extra family members)
$75.00AUD
Signature (try your best)*

Clear
OFFICE USE ONLY

      Club Meeting Endorsement:

It was moved at the Club Meeting on: .……./ .……./ 20…….. that the applicant be accepted as a member.

Membership fees paid Yes / No

Proposed By:_______________________

Signature _________________________

Seconded By:_______________________

Signature __________________________

Carried Yes / No
Should be Empty:

Riley Motor Club Qld Inc

Application for membership