Veteran Car Club of WA (Inc)

Surname:Mr. / Mrs. / Ms…………………………………….. First Name: ……………………………………..….

Mr. / Mrs. / Ms.(if surname is different)

Name for badge: ………………………………….... Partners name for badge: ………...... …………….

Address:…………………………………………………………………………….… Post Code: ……………..

Phone:(H) ……………………… (Mob.) ………………………….………(B) …………………………………

Email: …………………………………………………… Occupation: …………………………………………….

I wish to specifically join the ………………………………………Branch/Section of the Club – see below for list

Eligible Club Vehicles – please note that vehicles must be 25 years or older to be eligiblefor Club events

YearMakeType Restored or Unrestored (please circle)

…………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………

• I hereby agree to abide by the regulations and constitution of the Veteran Car Club of WA (Inc). My subscription is tendered herewith and is returnable should I not be accepted.
• I give permission for my personal details to be used within the Veteran Car Club of WA (Inc)and published in official publications and correspondence of the Veteran Car Club of WA (Inc)
• A copy of the Constitution of the Veteran Car Club of WA (Inc) can be made available on request
• Complete application form must be accompanied with full payment – see below

Applicants’ Signature:…………………………………………………..…..…. Date …..…./…..…./…..….

Proposed by:……………………………………………….…..……….………………………………

Name Signature

Please post to the VCC of WA (Inc), Membership Registrar,855 Sexton Street. SawyersValley 6074. All enquires to the Membership Registrar, Charles Heinrich08 9295 6336

Email:

Club meetings are held on the 4th Thursday of each month (except December), at the Clubrooms,

265 Hale Rd(corner ofTonkin Hwy), Wattle Grove at 8pm.

Membership Fees Metropolitan (Inc GST)

Joining betweenMetro SubscriptionNomination FeeAmount Payable

1 August – 31 October$75.00 $22.00 $97.00

1 November – 31 January$56.20 $22.00 $78.20

1 February – 30 April$37.50 $22.00 $59.50

1 May – 31 July$18.75 $22.00 $40.75

Membership Fees Country(Inc GST)

Joining betweenCountry SubscriptionNomination FeeAmount Payable

1 August – 31 October$70.00 $22.00 $92.00

1 November – 31 January$52.25 $22.00 $74.25

1 February – 30 April$35.00 $22.00 $57.00

1 May – 31 July$17.50 $22.00 $39.50

Visa Master Card Cash Cheque / money order (tick one)

CREDIT CARD PAYMENT: Amount $……………… Signature……………………….….……..……………

Card Number: …………………………………………Expiry Date ………/………

Name on Card: ……………………………………………………………………………………………………….

Country BranchesAlbanyph: 08 9841 1550Busseltonph: 08 9751 1546Collie ph: 08 9734 2747

Katanning ph:9861 1379Midwest ph: 0417 940 042Peel ph: 08 95811632York ph: 9641 2246

Esperance ph: 0427 727 592Eastern Goldfields ph:9093 2445Warren/Blackwood ph: 9761 156

SectionsVeteran Section (pre 1919) ph: 9291 7272 Vintage Section (1919-1930) ph: 9397 7735

Post Vintage section (1931 to 25 years old) ph: 0438 861 954Military section ph: 9257 3910

Model T Ford section 9685 1261Humber Rootes Group section ph: 9571 2278 Mustang/Shelby Section ph: 0400 405 375 Club Web Site: