nEW OR RENEWAL

□ New            □ Renewal

□ 6 Months         □ 12 Months

NAME

STREET ADDRESS

SUBURB/POST CODE

PHONE (Home)

PHONE (Work)

PHONE (Mobile)

EMAIL

DOB (Optional)

OCCUPATION

INTEREST IN MOTORCYCLING

□ Sports         □ Touring

□ Other (please specify)

BIKE/S

OTHER MOTORCYCLE CLUB MEMBERSHIP

CAN YOU HELP?

(Clerical, Fundraising, Etc)

*ARE YOU INTERESTED IN BEING INCLUDED ON THE NATIONAL HOSPITALITY LIST?

□ Yes      □ No

*Please note

If you agree to be included in the National Hospitality List, only your name, state, phone number and email address will be published to members.

IF SO, WHAT CAN YOU OFFER?

□ Coffee & Chat      □ Overnight Accommodation

□Mechanical Advice/Assistance

COMMENTS