clubMINI NSW - MEMBERSHIP APPLICATION FORM

1	Complete details wherever you see a ?
2	Direct Deposit your membership fee [see below for details]
3	Email this form [as an attachment] to membership@nsw.clubmini.com.au 
4	Email membership@nsw.clubmini.com.au with any concerns

Member 1
Name			?
Email			?
DOB			?						[DD/MM/YYYY]

Member 2  [Joint Memberships Only]
Name			?
Email			?
DOB			?						[DD/MM/YYYY]

Address		?
Suburb			?
State			?
Postcode		?
Home Ph		?
Work Ph		?	
Mobile Ph		?

Your MINI
Model			Cooper / Cooper S				[delete where applicable]
Cabrio / John Cooper Works [JCW] 		[delete where applicable]
Year			?
Body Colour		?
Roof Colour		?	*** If you own 2 MINIs, please provide details for both ***
Registration		?

Membership Rates
Joining Fee	All Memberships / Once Only		$20
							  +
Full		Single 					$50		[delete where applicable]
Joint *					$75		[delete where applicable]
		Single Country +			$50		[delete where applicable]
		Joint Country *+			$75		[delete where applicable]

Associate #	Single 					$50		[delete where applicable]
Joint *					$75		[delete where applicable]

Direct Deposit Details	Bank			Westpac, Sydney Branch
				Account Name	clubMINI NSW Incorporated
BSB			032000
Account Number	501856

*** PLEASE USE YOUR SURNAME AS THE TRANSFER DESCRIPTION ***

By submitting this form you are applying for membership to clubMINI NSW and agree to abide by its constitution & rules.

Memberships run for 12 months from the date of initial application
* Joint/Family Memberships are for 2 individuals residing at the same address
+ Country Memberships are for individuals residing over 50km from the Sydney GPO
# Associate Memberships are for individuals that do not own a MINI
# Associate Members are entitled to all clubMINI Inc member benefits, with the exception of voting rights

Office Use Only	
Date Received		Received By		
Membership #		Receipt #