Membership

Application Fees

Ordinary Membership $65.00
Country Membership $55.00 (Residing outside the defined Metropolitan Area)

I hereby apply for membership of the Holden Car Club of WA (The Club), which will commence on payment of the appropriate application fee.

Membership shall be for the remainder of the membership year, which ceases on the 30th June in each year. I agree to be bound by any rules made from time to time and/or varied by the Club and that this membership is bound by the conditions printed below, which I have read, as evidenced by my signature affixed here under.

Structure of fees:
Join between July 1st and March 31st gives you a 12 month subscription.
Join between April 1st and June 30th gives you a 15 month subscription.

Applicant Details

MEMBERSHIP INCLUDES SPOUSE/PARTNER

Surname

Given Name

Date Of Birth

Spouse/ Partner Surname

Given Name:

Address:

Suburb

Post Code

Phone Number:

Mobile:

Email Address:

Alternative Email:

Type of Membership

Ordinary:

Country:

Methods of Payment include

Direct deposit: Holden Car Club of WA inc / BSB 066-162 / ACC 10856718

Please include surname in description

Personal Cheque - Australia Post Money Order - Payment at any General meeting.

VEHICLE DETAILS

1. Make:

Model:

Body Type:

Colour:

Registration No:

Year

2. Make:

Model:

Body Type:

Colour:

Registration No:

Year:

3. Make:

Model:

Body Type:

Colour:

Registration No:

Year:

The Club is exempt from all or any liability arising from: Loss or damage to any vehicle or property The personal injury or death of myself or any passenger as the case may be, howsoever caused, whether by negligence or otherwise which may occur whilst engaged in any Club activity

Signature

Date

CLUB USE ONLY

Receipt Issued

Date

Member Number:

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