EmailMe Form - HK HT HG Holden Owners Club of Qld Membership Form

Membership Options
New M'ship - $80
Renewal M'ship - $40
Postage Of Pack + $10
Name
First Last
D.O.B
Phone
Email
Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Shirt Size
Embroidered Name
Spouse / Partner
D.O.B
Child 1
D.O.B
Child 2
D.O.B
Child 3
D.O.B
Car 1 (pic of your car must be included with application)

Year

Model

Body Style

Rego No.

S.I.V Reg (Yes / No)
Car 1 Pic Upload
Car 2 (pic of your car must be included with application)

Year

Model

Body Style

Rego No.

S.I.V Reg (Yes / No)
Car 2 Pic Upload
Acknowledgement
I hereby apply for membership of the HK HT HG Holden Owners Club of Queensland Inc. and include the annual memberhip fee of $80 (new membership) or $40 (renewal membership). I certify that the details on this form are correct and understand that the club may use images of my car (which may include vision of my number plate) for promotional purposes. I acknowledge that if I cannot get to a club run or outing to collect my membership pack once it is ready for collection, I will have to pay postage costs of $10 to have it sent to me.
Signed :
Bank Account Details
Westpac Bank HK HT HG Holden Owners Club of Queensland Inc. BSB - 034 676 A/C - 487 600 Reference : Your Name
Club Contact Details
HK HT HG Holden Owners Club of Queensland Inc. P.O.Box 5130 Maroochydore BC 4558 E-mail : hktgclubqld@gmail.com