Holden Sporting Car Club of Victoria Inc.

P.O. Box 791, Melbourne, 3001

MEMBERSHIP APPLICATION / RENEWAL

 

 

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 as of the 1st of January to the 31st of December

Level 2 Licence can only be purchased at Club meetings or events.

Payment:

Cash:_____________________________________

Cheque:_____________________________________

Please return to:

The Membership Secretary, HSCCV Inc., P.O. Box 791 F, Melbourne, 3001.

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(Office Use):

Date Received:______________________________________________

Licence Processed:__________________________________________