Goulburn Motor Cycle Club
Mailing Address PO Box 360 Goulburn NSW 2580
Email: goulburnmcc@gmail.com
Established 1911
All Memberships expire on the 31 December each year
After that if you do not renew your membership you will remain a member unless we receive a letter of
resignation your status will be a non-financial member of The Club
2015 Fees – Please Tick the appropriate Membership Type
*Associate $10.00
Senior (over 16) $40.00
Junior (Under 16)
$30.00
Family (as appears on
Medicare card)$70.00
*An associate member has full voting Rights and is covered under the requirements of Incorporation and MNSW Insurance while engaged
in club Business, but they will not require a Competition License.
The information you enter below and payment of the appropriate fees will enable our club to issue
you with a Certificate to verify club Membership.
Goulburn Motorcycle Club Membership 2015
Surname
Date Form Filled out
First Name
Second Name
Street Address
Town
MA Comp License
State
Post Code
Phone Number
Date of Birth
Parent/ Guardian (if u/18)
Your Email address
Payment Method
Cash
Amount $
OFFICE FILE NUMBER
Cheque No:
Account name:
Amount $
Direct Deposit
Reference:(yourname/mship)
Goulburn MCC
BSB: 032721
Account: 259975
Amount $
OFFICE USE ONLY - DO NOT COMPLETE THIS SECTION
Date
Amount Received
Amount received by:
Cash:
Cheque No:
Amount $
Amount $
MNSW Receipt #
Payment advice received for direct deposit
payments
Affiliation certificate mailed or received by
member
#Direct Deposit
Reference:
Amount $
GMCC Receipt #
YES
NO
YES
NO
If you feel you have some special skills and would like to contribute outside of being a member come along to
a meeting: The club meets every first Tuesday of the month at 7.30 PM confirm with Club president for venue.
For now we hope you enjoy our club and thanks for joining the oldest continuing Motor Cycle Club in Australia.
President:
Richard Toparis Ph 0418482649