Your Name (required)

Your Email (required)

Date Of Birth: Day/Month/Year

Occupation:

Name of Spouce/Partner:

Spouce/Partners Date of Birth:

Spouce/Partners Occupation:

Your Drivers Licence Number:

Applicants Address:

Post Code:

Phone (BH):

Phone (AH):

ARE YOU A MEMBER OF ANOTHER CLUB OR AUTOMOTIVE ASSOCIATION?
YES  NO 

IF YES, WHICH:

TYPE OF VEHICLE/PROJECT VEHICLE:

MAKE:

MODEL:

YEAR:

REGO NUMBER:

DETAILS OF VEHICLE:

MEMBERSHIP FEE IS $30.00 PER FAMILY, PER YEAR PLUS A ONE OFF
ADMINISTRATION FEE OF $5.00

I HEREBY AGREE THAT THE ABOVE IS FACTUAL TO THE BEST OF MY
KNOWLEDGE. I ALSO AGREE TO ABIDE BY THE RULES AND BY-LAWS
OF HASTINGS OLD HOLDENS CAR CLUB of NSW Inc.
I Agree 

Please Type the letters and numbers above in here: