Gasworks Motorsport Inc Membership Application Form

To join Gasworks Motorsport Inc, please complete the Application Form below (or download the form to print out).

Membership Fees

There are three memberships
Single: $30.00 per year (or $90 for 3 years)
Junior: $25.00 per year for ages 6yr–16yrs (or $75 for 3 years)
Family: $40.00 per year (or $120 for 3 Years)
For details about payment options, please check at the end of form

Gasworks Motorsports Inc Membership Application

ALL fields are required, unless otherwise stated

New or Renewal
—Please choose an option—New Membership ApplicationMembership Renewal

If a Renewal, please enter your Membership Number

Membership Type
—Please choose an option—Individual ($30)Individual -- 3 Years ($90)Junior (Ages 6yr-16yr) -- 1 Year ($25)Junior (Ages 6yr-16yr) -- 3 Years ($75)Family ($40)Family -- 3 Years ($120)

Payment Method (see below for payment instructions)
—Please choose an option—Direct DepositChequeCash (at meetings only)

About You

Title
—Please choose an option—MrMrsMissMsMxDr

Firstname

Surname

Postal Address

Suburb

State
—Please choose an option—NSWACTNTQLDSAVICWA

Postcode

Telephone, include Area Code

Your Email

Date of Birth (DD-MMM-YYYY)

Gender
—Please choose an option—MaleFemaleOtherPrefer not to say

Areas of Interest

Your membership allows you to access all four Gasworks activities. Please let us know which areas particularly interest you
Illabo Motorsport ParkGasworks Vintage Speedway ClubGasworks Car ClubSpeedway Karts ClubMotorbike ClubStudent Mentoring Program

Historic Plates

Do you wish to register Historic Plates with Gasworks Motor Club?
—Please choose an option—Yes - Rego No's, Car Make and Colour listed in CommentsNo

Additional Comments

Comments (optional)

Acknowledgement

By submitting this form, I, the person named above;

• apply for membership to Gasworks Motorsport Inc

• I understand and accept the "Objectives of the Club" and agree to abide by the Constitution Rules governing the Club.

• I give permission to place my name and contact details on a list that will be circulated among executive committee members of Gasworks Motorsport Inc only.

Δ

 

Payment Options

• If paying by Direct Deposit:
  Bank: Westpac
  BSB: 032769
  Account Number: 611683
  Reference: Please list your “SURNAME FIRSTNAME Membership”
   
• If paying by cheque:
  Make payable to Gasworks Motorsport Inc
  Write “Membership application for SURNAME FIRSTNAME” on rear of cheque
  Send cheque (and printout of completed application form) to
  The Secretary
  Gasworks Motorsport Inc
  PO Box 367
  Junee NSW 2663
   
• If paying by cash:
  Cash is only accepted at meetings — DO NOT SEND CASH VIA MAIL!
  Please print a copy of the completed application form and bring along