CLUB MEMBERSHIP / RENEWAL APPLICATION FORM

YEARLY MEMBERSHIP

UNDER 16 FREE (NO SHIRT)

F27 MEMBERSHIP PRO RATA FEE AS FOLLOWS

Month Joining Fee

July $60.00

August $57.50

September $55.00

October $52.50

November $50.00

December $47.50

January $45.00

February $42.50

March $40.00

April $37.50

May $ 35.00

June $ 32.50

First Name

Last Name

Address

Phone Number

Colour

Club Shirt #1

This form to be submitted with your payment to the club Presidents.

Payments. Cash, Bank Deposit, Eftpos,- Sur charges apply.

Account name: Hunter Region Street Machine inc BSB: 637 000 Account: 722516591

Reference: NEW MEMBER Leave last name and phone number, as reference.

RENEWAL Leave last name and membership number, as reference.

Apply for membership of the Hunter Region Street Machine Inc, if accepted, I/We agree to support the club, actively participate, contribute assistance with events whenever possible and abide by the club’s constitution.Your Photo may be taken and used for HRSM advertising from time to time if you do not wish this to happen please send an email to hunterregionstreetmachine@gmail.com

Applicants Signature

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Date of Birth

Facebook Name or Handle (Required for Club FB Financial Members Page