MEMBERSHIP APPLICATION / RENEWAL

Holden Sporting Car Club
of Victoria Inc.

PO Box 791, Melbourne, 3001

Name(s): _____________________________________________________________________________________
Address: _____________________________________________________________________________________
Postcode: _______________________
Phone: A.H.: ______________________ B.H.: _______________________ Mobile: ________________________
E-Mail: _______________________________________________________________________________________
Occupation: __________________________________ Date(s) of Birth: _________________________________
Vehicle(s): ___________________________________________________________________________________
Reg. Numbers: ________________________________________________________________________________
Membership No(s): ____________ Introduced by: ___________________________ (New Members)
I am interested in: Motorkhana: ________ Race: ________ Rally: ________ Sprint: ________ Hillclimb: ________

 

I hereby certify that I will abide by the rules and regulations of the Holden Sporting Car Club of Victoria Inc. and also the
National Competition Rules of the Confederation of Australian Motor Sport with which this car club is affiliated.

Signed: ________________________________________ Dated: ____________________________

Membership Fees:

Single:

$48.00 full year

Please mark clearly.

Family:

$70.00 full year (must all be living in the same household)

Under 18:

$25.00 full year
Associate:
$25.00 full year (Bona fide members of non CAMS affiliated car clubs only.
 Proof of membership required.)

Membership runs for 12 months from the 1st of January to the 31st of December

please make cheques payable to 'Holden Sporting Car Club of Victoria'

Level 2 Licence can only be purchased at Club meetings or events.
Payment: Cash:
  Cheque:
 

Bank Payment to HSCCV account, ANZ BSB 013-250, Acc. No. 1016-73941

Please return (with cheque or EFT receipt if applicable) to:

The Membership Secretary, HSCCV Inc., PO Box 791, Melbourne, 3001.

-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

(Office Use):

Date Received:______________________________________________

Licence Processed:__________________________________________