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Application for Membership |
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Name: ______________________________________ |
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Address: |
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_______________________________________________________________
_______________________________________________________________
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State: |
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____________ |
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Postcode: |
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__________________ |
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Phone: |
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_____________________________ |
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Email Address: |
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_______________________________________________ |
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Postal Address (if different to above) |
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__________________________________
__________________________________
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Membership Fee (January to June) is $70-00.
Membership Fee (July to December) is $35-00.
Plus, Joining Fee for new members of $20-00. |
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Amount payable is: _________________________________
* Please make cheques payable to the Jensen car Club of Australia.
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We would appreciate a photo of your car, even if you decide not to join. |
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I agree to abide by the Jensen Car Club Constitution. |
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Signed (Date): |
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______________________________________________
______________________________________________
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Jensen Vehicle Data Section |
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Chassis Number: |
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___________________ |
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___________________ |
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Jensen Model: |
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Current Registration Number: |
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_____________________ |
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State: |
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_______________ |
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________________________________
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________________________________
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Previous Registration numbers (if known): |
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Known Previous Owners + history |
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_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
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Please send to: Anthony Plumb (Secretary)
122 Ryans Road,
Eltham VIC 3095 |
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