Queensland P76 Owners Club Inc. 2006

Membership Form

Queensland Club Membership details

Once only joining fee of A$10.00
Yearly membership is A$40.00 (from July to June) of which a percentage is used for Liability Insurance
Total=A$50.00

Require membership ?
YES
NO

I am registering as a
Full Member
Internet Member
Social Member

Members Name

ADDRESS

Postcode

Previous Car Club(if any)

Ph No:

Rego No_

Make of vehicle

Model

Year

Engine Type & Capacity

Paint color



Last updated
Dec, 2005
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