Online Application

1st January to 31 December Membership Fee

Price:

1 July to 31 December Half Year Membership Fee

Price:

Contact and Personal Details

Name*

First Last

Partner's Name

First Last

Phone (Mobile)

Phone (Home)

Phone (Work)

Partner's Phone (Home)

Partner's Phone (Mobile)

Partner's Phone (Work)

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Partner's Email

Occupation

Date of Birth

4WDing and Safety Details

Do you own a 4 Wheel Drive Vehicle?*

Yes
No

Number of years 4WDing*

Do you hold a First Aid Certificate?*

Yes
No

Please give details about the certificate

When does the certificate expire?

Have you had 4WD Driver Awareness/Training?*

Yes
No

Please give details about your training, including year taken*

Agreement

I/We certify/acknowledge:

my/our vehicle does have at least Third Party Property Damage Car Insurance, is registered and is in a Roadworthy condition and I/We accept full responsibility for such insurance as well as my/our driving ability/s.
I/we am/are the holder/s of a valid and current driver’s license and I/we accept that if the use of my/our valid driver’s license is lost, I/we shall not participate as a driver in any club event until such times as I/we have my/our valid driver’s license reinstated.
on acceptance of Membership I/we will receive a copy of the Club’s Constitution and By-Laws. I/We understand that I/we are required to read the By-Laws and follow them at all times. I/We understand the Committee Members are available at any time to give me/us with the full meaning of the interpretation of the By-Laws. I/We also understand that all the general road rules and regulations must be followed.
I/we agree the above information can be included on the Club Contact List and made available to other Club members.
If paying via EFT, fees must be received within 14 days of form submission or application becomes void.

Agreement*

I agree to the outlined terms

Payment method*

EFT / Direct Deposit

Club bank account details:

Suncorp Metway
BSB: 484 799
Account Number: 071427040

Use your name and ‘membership fees’ in the reference line.

Fees must be received within 14 days of form submission or application becomes void.

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