Club Membership Form

USA NCRS Membership No:(if member)

Application

New Membership

Renewal Membership

Surname:

First Name:

Date of Birth:

Address

Post/Zip Code

State

Country

H/ Phone

W/ Phone

M/ Phone

Occupation

Spouse /Partner Preferred Name

CURRENT VEHICLE(S) OWNED (for publication in the Members Directory)

Please use the following code to denote condition: (R) Restored, (UR) UN Restoration, (EO) Excellent Original, (GO) Good Original, (PO) Poor Original, (LH) Left hand Drive. (If insufficient space – please attach a further, separate listing).

Year

Body Style

Registration No.

Model

Make

Vehicle details included in the Members Directory

I DO NOT have any objection in having my vehicle details being included in the Members Directory circulated to all financial members.

I DO have any objection in having my vehicle details being included in the Members Directory circulated to all financial members.

All above details being included in the Members Directory

I DO NOT OBJECT to the above details being included in the Members Directory which will be circulated to all current financial members.

I OBJECT to the above details being included in the Members Directory which will be circulated to all current financial members.

Members Directory Information

I DO NOT AGREE that I will not use the information contained in the Members Directory for any purpose other than to contact another member to discuss matters of mutual interest. I will not divulge the contents of the Members Directory to any other person or corporate entity.

I AGREE that I will not use the information contained in the Members Directory for any purpose other than to contact another member to discuss matters of mutual interest. I will not divulge the contents of the Members Directory to any other person or corporate entity.

Date

Renewal Membership Fee: AUD $75.00
Payment Methods: EFT,
Payable to: NCRS Australia Inc. PO Box 292, Karrajong NSW 2758 Australia
Banking Details: A/C No: 10245414 BSB No: 062:595 (Please note membership number)

Date Received

Receipt No

EFT/Cash/Chq/MO No

Enquiries & Membership: membership@NCRS.com.au

National Corvette Restorer Society Australia Inc 9882798

NATIONAL CORVETTE RESTORER’S SOCIETY AUSTRALIA INC.
P.O Box 292 Kurrajong NSW 2758

For office use only

SPONSORS

NATIONAL CORVETTE RESTORER’S SOCIETY AUSTRALIA INC. P.O Box 292 Kurrajong NSW 2758

For office use only

SPONSORS

NATIONAL CORVETTE RESTORER’S SOCIETY AUSTRALIA INC.
P.O Box 292 Kurrajong NSW 2758