MEMBERSHIP

FIRST NAME: *

First Name

SURNAME: *

Family Name

NUMBER & STREET NAME: *

Number, Street Name, Suburb

SUBURB: *

STATE / TERRITORY: *

POST CODE: *

TELEPHONE NO: *

Mobile or other.

EMAIL: *

MAKE AND MODEL OF CAR: *

PREFERRED CAR NUMBER: *

(IF ANY)

MOTORSPORT AUSTRALIA LICENCE: *

LOG BOOK: Y/N

SUPPLEMENTARY REGULATIONS AVAILABLE ON OUR WEB SITE https://mscasa.com

MSCASA MEMBERSHIP: $ 25.00 *

Yearly Fee

MSCA CLOTH BADGES: $ 6.00

WINDSCREEN STICKERS: $ 2.00

ACCOUNT NAME: Marque Sports Car Association of South Australia Inc.

PAYMENT BY DIRECT CREDIT: BSB: 085 005

ACCOUNT NUMBER CHANGED: ACC: 98 384 8140

REF: Name & description

Send payment confirmation to: mscasasecretary@gmail.com

PLEASE NOTE: Payment for items listed here must be be made separately from Entry and Garage Hire payments.

SELECT CAR CLUB FROM DROPDOWN LIST BELOW: *

CAR CLUB BEING AFFILIATED MEMBER OF THE MARQUE SPORTS CAR ASSOCIATION OF STH AUST INC.

Image of current club financial membership card or other proof of membership. *

Drag & Drop Files, Choose Files to Upload

Please drop and drop a file/image of your current financial car club membership card or other proof here. Not your MSCASA membership card.

CAR CLUB MEMBERSHIP NUMBER: *

CAR CLUB MEMBERSHIP EXPIRY DATE: *

MODEL EXPIRY MOTORSPORT

I HEREBY MAKE APPLICATION FOR MEMBERSHIP TO JOIN THE MARQUE SPORTS CAR ASSOCIATION OF S.A. INC.

By either using the 'Signature by Drawing' or the 'Signature by Typing' boxes.

By signing, you confirm that the information provided is correct and you agree to the event terms and conditions.

DATE:

Signature by Drawing:

Clear Signature

Use mouse/stylus/touch screen to Sign, to confirm the information provided is correct and you agree to the event terms and conditions.

Signature by Typing:

Clear Signature

Use keyboard to type your signature, to confirm the information provided is correct and you agree to the event terms and conditions.

SUPPLEMENTARY REGULATIONS AVAILABLE ON OUR WEB SITE https://mscasa.com

I HEREBY MAKE APPLICATION FOR MEMBERSHIP TO JOIN THE MARQUE SPORTS CAR ASSOCIATION OF S.A. INC.

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