2015 Hartwell Motorcycle Club Membership Form

P.O. Box 2023, Bayswater, Vic 3153 Telephone/Fax/Ans Mach: (03) 9729 7729
info@hartwellmcc.org www.hartwellmcc.org

HARTWELL
MOTORCYCLE CLUB

Renewal:

Membership $75

Social [Non Racing] $30

[add $25 for New Senior Memberships]

Family: $90

Junior: $20

[New Junior Membership - No charge]

Name: [MR/MRS/MISS/MS]
Address:
Suburb:

State:

Date of Birth:
Grade:

P/Code:

Occupation:
NE

E [Circle one]

Types of Bike/s Raced:

N = Novice NE = Non Expert E = Expert

Email:
Phone: A/H

B/H

Fax
Newsletters by:

Mobile
*EMAIL

Pay by Credit Card:

Card Number:

Competition Licence Form required

POST

*Subscription

Yes

Amount

Mastercard Card Holder Signature:

Visa

No

to Newsletter via email can be completed online at www.hartwellmcc.org.

Expiry: