MEMBERSHIP REQUIRED Single / Family (Please
indicate type of membership sought by circling)
Are You a previous ASMF Member?
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 $30.00 AUD (Single Membership) or
$35.00 AUD (Family Membership) made payable to Australian Street Machine
Federation Queensland Division Inc. with this application. Please add $10 if applying from outside
Australia.
SIGNED:
DATE :
/ /
Please print out
form, then complete & send with remittance to.
Australian Street Machine FederationQueensland Division Inc