Australian Street Machine Federation

Queensland Division Inc.

 APPLICATION FOR MEMBERSHIP

MEMBERSHIP REQUIRED Single / Family (Please indicate type of membership sought by circling)
Are You a previous ASMF Member? No Yes If Yes, what was your membership number, if known?

Your Name

SURNAME:

FIRST NAME:

DATE OF BIRTH:

OCCUPATION:

Spouse / Partner Name

SURNAME:

FIRST NAME:

DATE OF BIRTH:

OCCUPATION:

Your Address

ADDRESS:

POST (ZIP) CODE :

State:

Country:

Your Phone Number

Home:-

Work:-

DETAILS OF VEHICLE/S (If more than one vehicle please attach list):-

REGO NO: 

MAKE:

MODEL: 

YEAR: 

CAR CLUB (If Applicable): 

Paint and body details:-

 Engine and Drivetrain details:-

Modifications (if any):-

 

 I hereby agree that the above information is true and factual to the best of my knowlege, and I agree to abide by the rules, by-laws of and objectives of the ASMF.
Enclosed is a cheque/money order for $35.00 AUD (Single Membership) or $45.00 AUD (Family Membership) made payable to Australian Street Machine Federation Queensland Division Inc. with this application.
Please add $15 if applying from outside Australia.

SIGNED: 

DATE  :          /         /

Please print out form, then complete & send with remittance to.

Australian Street Machine FederationQueensland Division Inc

Po Box 5443 West End, QUEENSLAND, AUSTRALIA 4101

OFFICE USE ONLY

Date Received:

Date Joined:

Receipt No:

Type of Membership SINGLE /FAMILY

Amount Received:

Membership Sent:

Computer File Updated: