HISTORIC COMMERCIAL VEHICLE CLUB of AUSTRALIA Inc.
P. O. BOX 2020, BAYSWATER VIC. 3153
ABN 91 234 329 739 AIN A0001372B
H.C.V.C.A. Message Phone 0400 025 525
JOINING MEMBER APPLICATION FORM(2018-2019)
PLEASE COMPLETE ALL APPLICABLE FIELDS and forward WITH PAYMENT as per the instructions detailed below.
Title(e.g. Mr/Mrs/Ms) Initials Surname _
Given Names Preferred “First” Name _
Home Phone( ) Mobile Phone _
If you would like to have your Spouse/Partner included as part of your membership, complete the following
Preferred“First” Name Surname (if different to yours) _
Property/ Company / Group Name(If Applicable) _
Actual Residential Address _
Town / Suburb State Postcode _
Postal Address(If different to above) _
Town / Suburb State Postcode _
E-Mail Address(print clearly) _
If admitted as a Member, I agree to be bound by the rules of the Club which are in force from time to time. I confirm that the details given hereon are true and correct and may be used by the HCVCA Committee and Sub Committees. These details may not be provided to any third party or the General Membershipin a manner which would otherwise identify me without my written consent.
Signature of Applicant ______Date ______
Proposed for Membership by (If you know a member) _
Signature of Proposer ______(Being a financial member of the club)
DETAILS of HISTORIC VEHICLES OWNED (if any):-
TYPE RESTOREDREGISTERED
MAKEYEARMODEL(P-Mover, Yes/No/BeingYes/No/Club- Tray etc.) (Circle) -Permit*
Y / N / BY/N / C-P
Y / N / BY / N / C-P
Y / N / BY / N / C-P
*C-P Sponsor Club _
SUBSCRIPTIONS
Joining Fee is $10.00 plus Annual Membership fee of$70.00 (to next February 28th) = Total$80.00
Spouse Membership $10.00
INSTRUCTIONS AND IMPORTANT INFORMATION
Please attach Cheque or Money Order (NO CASH IF BY POST) for $80.00 payable to:
HISTORIC COMMERCIAL VEHICLE CLUB of AUSTRALIA Inc.
and forward your application toThe Secretary, HCVCA, P.O. Box 2020, Bayswater VIC 3153.
If your application is accepted the funds will be banked and a Welcome Kit including a receipt will be mailed to you in due course. Please allow 1 month approximately for approvals and processing. If you have then not heard from us, feel free to send an email to:
[Note: Pro-Rata Adjustments (if eligible) will be advised for your first renewal in February next year]
Club Use Only
Club Officer Approval 1 ______Club Officer Approval 2 ______
Joined Date: ______Membership No.:______Receipt No. ______: ,
Added to DatabaseMailing List:New Member Pack sent: Name Badge Ordered:
Form HCVCA01 Mar 2015