Membership Application

Lions Pride Holden Car Club Inc.

Please tick preferred State VIC. NSW

PO Box 9053, SCORESBY 3179 PO Box 392, PLUMPTON 2761

Annual Subscription Fee: $35 for Single and family.

Note: Fees must accompany this application.

Surname:.................................................................... Given Name(s):.........................................................

Address:...............................................................................................................................................................

...........………...................................................Postcode:.....................

Date of Birth:...................…......

Telephone: (Home):............................... (Mobile):................................. (Work):...............................

Email address:………………………………………………..

Model of Car:................... Year:.................. Comments:......................................................................

If more than 1 car owned, please give details:......................................................................................................

Type of membership applied for Single Family

Applicable to family membership only

Spouses name:...................................................... Date of Birth:...........................

I/we hereby wish to become a member of the Lions Pride Holden Car Club Inc. and in the event of my/our admission as a member, I/we agree to be bound by the Rules of the Association as specified.

Signature of Applicant:...................................................................... Date:................................................

How did you become aware of the Lions Pride Holden Car Club Inc.?

Radio/TV/Newspapers Car Magazine (specify)……………………………..

From a current Club member Swap Meet/Car Show

Internet Other (specify)……………………………………..

Office Use Only

Amount received:............................. Date:............................. Signature:................................................

Referred to Committee: Approve: Reject:

Signature:.............................................. Membership No(s) issued:……..……........Date:.……..……......