PO Box 321
EASTWOOD NSW 2122
AUSTRALIA
APPLICATION FOR MEMBERSHIP / RENEWAL OF MEMBERSHIP.
I/We: ______
Of: ______
Occupation/s: ______
Phone(H): ______(W): ______Membership No/s: ______
Mobile/Pager: ______Email address: ______
I/We hereby apply for *membership/*renewal of membership for the year ending AGM date 2012. Enclosed herewith please find *my/*our *cash/*direct deposit/*money order/*cheque for *single/*family membership.
Amount: New membership *Single $40.00 / *Family $55.00 * $10.00 Parts Levy included,
Renewal * Single $30.00 / *Family $45.00 - Cash, Direct Deposit, Postal Order or Cheque.
The preferred method is Cash, Direct Deposit or Postal Order. Sending a cheque is Your last option !
Up to 3 months before AGM membership is half price for new members only and no Club
Badge until 1 year of full membership.
You can also directly deposit funds into our account at Credit Union Australia.
Branch: Shop 1105, Westfield Shopping Centre, 159-175 Church Street, Parramatta NSW 2150.
BSB: 814-282 Account Number: 10263737 Phone: 02 9893 7477.
Or you can pay in person at a club event.
______/______
Signature Signature
Please note our updated details as follows:
A My/our preferred Sloppy-Jo/T-shirt size/s: SJ______TS______
B Bikes presently owned: ______
C Bike ownership remains identical to previous years (continuing members): Yes/No
If No, updated details as follows: ______
D I am/we are Laverda nutters interested in the following:
Day Runs Parties Workshop days Weekend Runs Socials
Theatre/Restaurant Interstate Runs BBQ Concourse Rallies
Racing (Spectator) Technical Advice Spare Parts Racing (Self) Other
E I/We would like to see:
1. Continued support for Laverda/Moto Guzzi/Ducati functions Yes / No
2. Other: ______Yes / No
F I/We can offer the following services to Club Laverda NSW and / or its members:
1. Accommodation Yes / No
2. Maintenance assistance Yes / No
3. Specialty knowledge Yes / No
4. Time, Money etc. ______Yes / No