Name : ................................................................................................................................................
Address : ............................................................................................................................................
........................................................................................ Postcode : ..................................................
Year of Birth : .....................................................................................................................................
Are you a previous member? YES / No Club (Name : .............................................) or Individual?
Occupation : .........................................................................................................................................
Telephone 1 : ..................................................Telephone 2 : ..............................................................
Current ASRF Class vehicle : (make / year / model)
...............................................................................................................................................................
Payment details
BANKCARD [........] VISA [ ........] MASTERCARD [........]
NUMBER [......................] [......................] [......................]
[......................]
EXPIRY DATE : ...... / ...... / ...... Signature : ......................................................................................
I wish to become an individual member of the Australian Street Rod Federation and agree to comply with the rules of the Federation at all times.
Enclosed is my membership fee (Members of ASRF affiliated Clubs, contact the National Office for Pro Rata Amount)
Signed : ......................................................................................... Date : ..........................................
Send to : -
Australian Street Rod Federation PO Box 556 Southport D.C. Queensland 4215 Fax : +61 7 5528 1709
E-Mail : [email protected]
