Membership Form

Sign Up for Annual Membership

Membership covers the period 1st July to 30th June each year

For further information about the club please contact

(If vehicle registered in joint names please also complete Section 2. Below)

(If vehicle registered in Company name, please also complete Section 3. Below)

1. Member Details
Membership Application or Renewal 7 Benjamin Street, Newton SA 5074
Family Name*
First
Given Name*
First
Postal Address*
Home Phone
Mobile*
E-mail Address (please print)*
Yearly membership for Full Members includes immediate family (partner and dependent children/students) living at the same address. Family members must be notified below to be included as Family Members.

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Annual Membership Fees
Annual Membership Fees
- Joining Fee $20
- Full Membership (Single/Family) $70
- Incorporated Bodies $60
- Associate Member $40
Membership covers the period 1st July to 30th June each year.
Payment must be forwarded with application/renewal form.
EFT Payment
- Payment by EFT (BSB Details below *)
(Please reference EFT payment with your name)
Date of EFT*
Cheque attached
- Cheque attached
Cash
- Cash
(Please pay in person to Treasurer or Secretary)
*BSB No. 015-310; Acct No. 426963605
Agree the terms*
I agree that if I am accepted as a member of the STREET OUTLAWS CAR CLUB Inc., I will be bound by the constitution of the club and release the association from any liability, either personal or to the property that may arise from any correct information provided by me or as a result of any breach by me of the associations constitution and rules.

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