Member Information

Given name : Surname:
Partner:
Address :
Suburb: Post Code: 
Occupation : D.O.B :
Phone: (H) :

(W) :

 

 Mob :

Facsimile :

Email :

Web Site:
Mem No. :
CAMS Lic No:

Car Details
 Make : Year:
 Model : Condition :
Log Book No.  ( Historic ) :
C of D.  No. : Race No. :
Year Car Represents :

Livery on Car :

Previous Owners
1.
2.
3.

     Please email any current or period photos to webmaster@groupc.org.au                       

*If more than one car is owned please submit details on a new form.  

NOTE. :

The information contained on this form is for the sole internal use and records of the association and to allow fast and effective contact with you so that we can  provide information to  assist you, so that you can race and or enjoy  your car. Under no circumstances will any details contained on this form be passed on to or sold to a third party without your prior consent.