Goulburn Motorcycle Club
Mailing Address PO Box 360 Goulburn NSW 2580
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
THIS IS A JUNIOR MEMBERSHIP UNDER 16 Yrs old MEMBERSHIP IS $30.00
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 Junior Membership 2014
Surname
Date Form Filled out
First Name
Parent/Guardian First
name
Second Name
Parent/Guardian Last
name
Street Address
Town
State
Post Code
Phone Number
Date of Birth
MA Comp License (if Held)
Your Email address
Payment Method
Cash
Cheque No:
#Direct Deposit
Reference:
Amount $
Amount $
Amount $
OFFICE USE ONLY - DO NOT COMPLETE THIS SECTION
OFFICE FILE NUMBER
Date
Amont Recieved
Cash:
Cheque No:
Amount $
Amount $
MCNSW 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