HSCC Membership Form

Membership Application New/Renewal

Member Details
Name*

First NameLast Name
Date*

DayMonthYear
Date
Membership Number (if known)
Member nr
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth

DayMonthYear
DOB
Contact Details
Mobile Number*
04** *** ***
Other Contact Number (if applicable)
Email*
example@example.com
Membership Fees & Payment Details
Type of Membership*
*Family membership is for the same family living at same address (includes children under 18) Separate from must be filled out for each FAMILY member.
Payment Options*
Electronic Payments

Hastings Sporting Car Club

BSB: 932000

Acct: 151254

Please use your last name as a reference or we will not know who has paid and your membership may not be valid.
Date of Payment

DayMonthYear
Date membership paid
Should be Empty:

Membership Application New/Renewal