VETERAN VINTAGE AND CLASSIC MOTOR CYCLE CLUB ACT INC.

(incorporated under the Associations Incorporation Act 1991)

APPLICATION FOR MEMBERSHIP

(for use only when applying by email and paying fees by direct deposit or Internet banking)

On completion of this form, please email it to


(full name of primary riding member – see Note) / Please read the conditions that applicants for membership need to acknowledge.

(date of birth of primary riding member) / Acknowledgement:
Applicants' names that appear in this form acknowledge that they have read and understood the Club Rules (available to view on VVCMCC web site via the ‘About the Club’ link in the main menu) and, on granting membership for the term of the membership period shown below, acknowledge that the Club and those bodies with which the Club is affiliated, have no responsibilities for any damage or theft of machinery or possessions or any bodily injury sustained during the course of participating in Club events. Disagreement to these conditions may result in the renewal for membership being rejected.
Please note agreement/disagreement by crossing out that which is not applicable.


(preferred or introduction name - primary riding member)

Spouse/partner’s preferred name)

(full name of family/additional riding member – see Note)

(preferred/introductory name family/ additional riding member)
POSTAL ADDRESS

(No and Street Name) / Note on Membership: A single full or senior membership covers membership for one member (primary riding member) and partner living at the same address. An additional fee of $5/nominee applies for Family Membership (includes additional riding members), which entitles the partner to have the privileges of a full member in respect of voting on Club issues, access to the Concessional Registration Scheme for veteran, vintage or historical motorcycle/vehicle, and family attendance at Club subsided functions. New membership fees are charged pro-rata when joining after 1 August.

(suburb)

(State)

(Post Code)

(E-mail)

MEMBERSHIP FEES(for the membership period ending on 30 April next)

CATEGORY / 1 May-31 Jul / 1 Aug-31 Oct / 1 Nov-31 Jan / 1 Feb-30 Apr / PAID
Joining Fee / $5 / $5 / $5 / $5
Full Member / $30 / $22.50 / $15 / $7.50
Senior Member (aged 65+) / $20 / $15 / $10 / $5
Fee for Family/Additional
Rider Membership / $5/nominee / $5/nominee / $5/nominee / $5/nominee
NOTE: After completing this part of the form, enter bank transaction details in the table on the next page. / TOTAL / $

Bank Transaction Information:

VVCMCC Bank Details / Member’s Payment Details
BSB: 112908 / Date of Transaction:
Account Number: 126370971 / Transaction Type: Transfer to account or deposit at St George Bank branch (delete one) / Deposit / Transfer
Account Name: The Veteran & Vintage Motor Cycle Club ACT, Inc / Transaction Identifier (as provided to St George Bank):
Amount Transferred/Deposited: / $

After completing bank transaction details, save the completed form (suggest re-naming it ‘name_application.doc’where ‘name’ is your surname) and email it to .

Please add any comments in the box below (e.g. if more than one additional rider is being nominated, use this comments box to list their details):

(THIS SECTION FOR USE OF CLUB OFFICIALS ONLY)

RECEIPT NUMBER / MEMBERSHIP NUMBER
RECEIPT DATED / MEMBERSHIP LIST UPDATED
AMOUNT PAID / MEM CARD & RULES FORWARDED
CARD FILE UPDATED