This form should be completed for all club trips when a *temporary member/guest is attending as a passenger or driving his / her own vehicle. Submit the completed and signed form to the Trip Leader.
TRIP:______DESTINATION:______
DATE/S: ______TRIP LEADER:______
*TEMPORARY MEMBERSHIP/GUEST FEE $20. Single or Family or $10 per Child per trip. (If not covered within the family membership application). Single Membership Family Membership Child Membership
TEMPORARY MEMBERSHIP INFORMATION
PERSONAL DETAILS:
NAME:______
ADDRESS:______
POSTCODE:______PHONE NUMBERS:_(H)______(M)______
PASSENGERS:______
VEHICLE MAKE:______MODEL:______
REGISTRATION:______DRIVERS LICENCE No: ______EXP Date:______
For Emergency Purpose - 2 Contact persons other than detailed above:
Full Name______Contact Nos.______
Full Name______Contact Nos.______
FIRST AID TRAINING: None Level 1 Level 2 Above
DRIVER TRAINING: None Beginner Beg / Int Intermediate Int / Adv Advanced
Complete and sign separate Personal Details Form – hand over to Trip Leader
1) As a temporary member you are representing the Pajero 4WD Club of Victoria Inc. and are expected to conduct yourself in a fit manner and abide by our Rules and By-laws. If you are not familiar with our Rules or By-laws please ask the Trip Leader to explain them or where you can obtain a copy to read.
2) If you are not confident or do not wish to attempt any part of an event, it is your responsibility to inform the Trip Leader.
3) In the event of vehicle recovery, it is the vehicle owner’s responsibility to approve recovery attachment points, and where safe, to perform the attachment.
4) Safe driving practices must be adhered to at all times.
5) Please check your vehicle insurance to ensure it has the appropriate level of cover.
6) Whilst on a Club trip you are covered by the FWDV’s public liability & personal accident insurance.
7) Visitors may attend no more than “two trips” as a Temporary Member prior to joining the Club.
8) The Trip leader has the right to refuse any temporary membership be that as participant in or a driver of their own vehicle on sanctioned Club trip.
Trip Leader’s Guidelines – Trip Forms 20131210
CONDITIONS AND DECLARATION
REGISTRATION AND INSURANCE:
All vehicles participating in the Pajero Club’s trips and activities must be registered and maintained in a roadworthy condition, having as a minimum, Third Party Property motor vehicle insurance cover.
GENERAL INDEMNITY:
Upon acceptance by the Pajero Club of this application, the applicant (s) whose signature appears on the form, do hereby indemnify and keep indemnified the Pajero Club, its officers, members, servants, or agents, in so far as they are not legally entitled to be indemnified under any policy of insurance whatsoever, from and against any damages, claims or demands whatsoever which may befall or occur to themselves, their spouse, children, guests, or visitors as a consequence of or arising out of the Pajero Club activities or functions.
MEDICAL INDEMNITY:
The applicant(s) whose signature appears on the form, further authorise any officers, members, or servants of the Pajero Club in the event of any accident or illness befalling them whilst engaged in any Pajero Club activity or function to obtain any medical assistance or treatment whatsoever and for this purpose engage any doctors, nursing assistants or hospital accommodation and in this event agree to pay all such doctors, nurses, or hospital fees and expenses other than fees and expenses recoverable under any policy of insurance whatsoever, such fees to be paid to the Pajero Club on demand.
DEPENDANTS
Means unmarried children, primarily dependent on you for maintenance and support, over 6 months and under 19, or under 25 if a full-time student at an accredited institution of higher learning. Includes step or legally adopted children.
ACCEPTANCE / ACKNOWLEDGEMENT
I/we hereby make application for Temporary Membership to the Pajero 4WD Club of Victoria Inc (Pajero Club).
I / We hereby agree to abide by the Rules and Bylaws of the Club at all times.
I / We certify that the above vehicle is Registered and is Roadworthy and as such, conforms to the requirements of the Club’s insurance policy and understand that every person and vehicle participating in any activity do so at their own risk.
The information collected for this application is solely for the use of the administration of the Pajero Club and the trips/events it conducts. To keep our administration costs (thus our annual fees) low, the Pajero Club prefers to send notices, minutes, newsletters, trip details etc. to members via the Internet e-mail. Faxing or surface mail will be used for members without an e-mail address. This information is considered private and confidential and will not be used, sold or given to any other organisation or person for any other purpose without your express permission. This information will also be used to fulfil the Pajero Club’s obligations as an affiliated member of Four Wheel Drive Victoria
Trip Leader’s Guidelines – Trip Forms 20131210
Signature of Applicant: Date:
Signature of Proposer: Membership No. Date:
Signature of Trip Leader: Membership No. Date:
*TEMPORARY MEMBERSHIP/GUEST FEE $20. Single or Family or $10 per Child per trip. (If not covered within the family membership application). Single Membership Family Membership Child Membership
Once details on this application have been completed and signed by all, please forward it, along with your payment to the TRIP LEADER. This will then be forwarded to the Membership Secretary at a monthly meeting.
Membership Secretary, Pajero 4WD Club of Victoria, P.O. Box 117, Mitcham VIC 3132
Cheque Cash Direct Deposit to CBA: BSB 063 213 A/C 00900831
Account Name: Pajero 4WD Club of Victoria Inc.
Credit Card Name on Card:
Signature: Amount $
Credit Card Number Expiry Date
Trip Leader’s Guidelines – Trip Forms 20131210