24-25 Austin A40 Car Club Membership Form

Austin A40 Car Club of Australia Inc

2024 / 2025 Membership Form
All Club Memberships expire June 30 each year and consequently must be renewed by existing members. Therefore, we ask you to please complete all the following information and submit this form. Once you have submitted the form you will also need to pay your membership via Bank transfer (EFT)

As of this year bank transfer is the only method of payment that will be accepted from your membership fee.

Please make payment to the following account.

Please ensure you use your Full Name as the reference when submitting your Bank Transfer.

Account Name: Austin A40 Car Club of Australia

BSB: 633 000

Account No: 133 199 471

MEMBERSHIP WILL NOT BE ACTIVE UNTIL PAYMENT IS RECIEVED
Membership Type and Fee
Indicate which fees applies to you*

New Full Membership joining fee ($10) & Annual Subscription Fee ($60) = $70New Full Membership joining fee ($10) & Half year subscription ($30), only applies to new members joining between December 1 and June 30 2025 = $40Annual Full Membership Subscription Renewal = $60
Personal Details

Please Note: A Full Member of the A40 Club may nominate a spouse or partner at no additional cost who, as an Associate Member, is welcome to enjoy the benefit of the Club and may participate in Club activities but will not normally have voting rights unless they become an ordinary full member upon payment of a Full Membership Subscription
Full Member Name:*

First NameLast Name
Email
example@example.com
Full Member Phone number*
Please enter a valid phone number.
Spouse / Partner Name:

First NameLast Name
Spouse / Partner Phone Number:
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Other Participants (e.g. children)
Membership List

From time to time, a current membership list will be circulated between all club members. This membership list will include members & partners names, email and phone numbers. Please indicate if you would like to be included. If you choose not be be included your details will remain confidential.
Do you want your details included in the membership list*

YesNo
Car Details

Please ensure you include all cars on Club Permit Scheme (CPS) with the A40 Club or they will be removed from the register
Car 1 Details Rego Number Make Model Body Type Year Colour Engine/Chassi No:
Is this car on club permit scheme with A40 Car Club
Car 2 Details Rego Number Make Model Body Type Year Colour Engine/Chassi No:
Is this car on club permit scheme with A40 Car Club
Car 3 Details Rego Number Make Model Body Type Year Colour Engine/Chassi No:
Is this car on club permit scheme with A40 Car Club
Car 4 Details Rego Number Make Model Body Type Year Colour Engine/Chassi No:
Is this car on club permit scheme with A40 Car Club
Car 5 Details Rego Number Make Model Body Type Year Colour Engine/Chassi No:
Is this car on club permit scheme with A40 Car Club
Car 6 Details Rego Number Make Model Body Type Year Colour Engine/Chassi No:
Is this car on club permit scheme with A40 Car Club
Include the details of any additional cars you have on Club Permit Scheme. Include same details as above
Agreement

By submitting this form you agree to abide by the rules of the above Club and absolve the said Club of any liability whilst participating in any Club activity.
Office Use Only
Payment Recieved

YesNo
Date

DayMonthYear
Date
Should be Empty:

Austin A40 Car Club of Australia Inc

Please ensure you use your Full Name as the reference when submitting your Bank Transfer.

Membership Type and Fee

Personal Details

Membership List

Car Details

Agreement

Office Use Only

**Please ensure you use your Full Name as the reference when submitting your Bank Transfer.**