NEW MEMBERSHIP APPLICATION NO. MG CAR CLUB NEWCASTLE INC ABN : 96 210 450 708 CLUB PHONE (02) 49270550 PLEASE COMPLETE ALL DETAILS & RETURN TO ANNMAREE HARRIS 29 Wyndham Street GRETA NSW 2334 For all membership enquiries please phone (02) 49387715 Personal Details (all applicants to complete this section) 1st Membership Details: Surname (Mr/Mrs/Ms/Miss) ____________________________ Given Names____________________________________ Address____________________________________________________________________________Post Code__________ Phone:Home__________________Work________________Mobile_____________________Occupation________________ Email address 1st member______________________________________2nd member________________________________ 2nd Family Member Details: Surname (Mr/Mrs/Ms/Miss) _____________________________Given Names_____________________________________ Phone: Work______________________Mobile_______________________Occupation______________________________ DETAILS OF CAR. Do you own an MG YES/NO. Model_____________________________________________________ Please contact Register Secretary for enquiries regarding Historic Plates with details of your MG’s . OTHER VEHICLE Make and Model__________________________________________________________________________________ I/We hereby apply for membership of MG Car Club Newcastle. MEMBERSHIP QUALIFICATIONS . Any person who is or has been an owner of an MG Motor Car or who is in sympathy with the objects of the club and agrees if accepted to abide by the rules of the Club Signature (1st applicant) ____________________________ (2 nd applicant) ______________________________ Date ________________ The above named applicant/s is/are nominated for Membership of the MG Car Club Newcastle by: (1) Name__________________________________ Member No. _____________ Signature_________________________ __ (2) Name __________________________________Member No.______________Signature____________________________ (The above nominators must be financial members of the MG Car Club Newcastle) Magazine Delivery (Please circle preference ) Mail Website ____________________________________________________________________________________________________ JUNIOR MEMBERS – must be under 18 years on 1st January . Parent/Guardians to complete. I, (print full name) ___________________________________ am the parent/guardian of the above junior member and I hereby consent to the above named minor joining the MG Car Club Newcastle. Club Junior D.O.B ______/______/____________ Signature of Parent/ Guardian if Junior Applicant (under 18 years of age) Signature____________________________________________________ Date ______________________ CLUB FEES –DUE PER ANNUM from 1st January to 31st December (Includes GST) JOINING FEE $25.00 ( ) NEW MEMBERS ONLY(EXCEPT JUNIORS) FULL MEMBERSHIP – own or owned MG $55.00 ( ) MG Owner ASSOCIATE MEMBERSHIP $45.00 ( )Non MG Owner FAMILY (2 MEMBERS) – FULL $65.00 ( )MG Owners Tick one FAMILY (2 MEMBERS) – ASSOC $55.00 ( )Non MG Owners JUNIOR MEMBERSHIP $20.00 ( ) Credit card Administration Fee $3.00 ( ) TOTAL PAYABLE $______________ Cheque / Credit card/ Cash [ ] Note: After 1st October, fee will cover to 31st December of the following year CREDIT CARD MAIL ORDER AUTHORITY - Please Debit my card a total $ ____________________ (please add Credit Card Fee) Cardholder’s Name (as shown on Card) ________________________________________________________ [ ] Receipt No: Card Number _____________________________________________________________________________ Cardholder’s Signature_______________________________________Expiry date__________/__________ ____________________________________________________________________________________________________ Office Use Only Interim Receipt / Membership Tear off section Received from………………………………………the sum of $………. 00 for…………………………membership of MG Car Club Newcastle. (Full. Associate, Junior) This membership is subject to acceptance by MGCC Newcastle committee at next monthly committee meeting Signed…………………………………………… Club Position……………………………. Date………/……/…200