Membership form
The Secretary
FIAT CLUB of the ACT (Inc)
PO Box 1119
CANBERRA CITY ACT 2601
Application for Membership 2011 to 2012
Dear Secretary,
I hereby apply for membership to the FIAT CLUB of the ACT (Inc.).
Name:
Address:
Telephone:
(Home)
(Work)
e-mail address:
Car(s):- Model / Colour / Registration Number.
Eg: - 1973 / Fiat / 132GLS / Met Blue / YUQ 132
The CLUB's financial year commences on the 1st October and the
annual
membership subscription is $35.00 for either single or
family membership and $20 for Inter-State Memberships.
Please fill in the names of partner and/or children (under 18)
for family membership.
Name:
Relationship:
Club interests:
Social activities
Motorsport
Car displays
Magazine
Technical help
Other - please specify
The FIAT CLUB of the ACT (Inc.) is not liable for any personal injury, property damage,
or
economic loss how forever caused to members or persons travelling with members, or arising
from, or in association with any activity conducted by, or under the supervision of this
Club.
I agree to abide by the Constitution and By-Laws of the CLUB.
Signature:
Date:
FOR TREASURER'S USE ONLY:
Membership No:
Reciept No:
