Membership Form

Please complete the form below and click the 'Send' button.

Applicant Full Name *

Age Range *

Partner Spouse Name

Age Range:

Children under 18

Postal Address *

Email address *

Home Phone No.

Work Phone No.

Mobile

...............................Please Enter - Year; Make; Model; Colour; Reg. No.

Vehicles

Do you have a Race Licence?

If anyone else on this application has a race licence please enter their name/s here:

Names:

Would you like your printed Bulletin monthly magazine by email Y/N?

Select Activities in which you are Interested

Other Activities *

Subscription Full April - Sept select one

Subscription Oct - Dec Select one

Subscription Jan - Mar select one

Method of Payment

Which image is the Flower?

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INTERNET BANKING: If you want to pay by Internet banking our bank a/c No. is 03-0539-0165992-00 Please place your name and 'New Subscription' in the reference fields