* FAMILY / JUNIOR RIDERS under 16. Name: ________________________ Age: __________

* Email (for S.M.C.C. bulletins)________________________________________ * P/Code: __________

____________________________

SMCC is a volunteer based club. We rely on the contribution our members to run club activities.

* Signed: * Date: (signature by Parent or Guardian if under 18 )

Section 2: MEMBERSHIP TYPE (please tick)

Membership type:

Status: NEW MEMBER RENEWAL PAST MEMBER RETURNING DUAL MEMBER SMCC / GMCC (Associate)

Primary interests: FUN / RECREATIONAL MX OFF ROAD MOTOTRIALS HISTORIC / RED PLATE Please indicate qualifications held : MV Official, e.g. level 1, 2, 3, 4

First Aid level

Section 3: MOTORCYCLING VICTORIA LICENCES (please tick) Do you have an M.V. licence? YES NO Do you require a license application form? YES NO Your M.V. licence no#______________ Type: Race or Recreational Expiry date: ______________

Section 4: FEES (Membership includes Newsletters)

Cash Receiving Club officer name

Cheque

EFT Total $

P.O Box 447Geelong 3220

www.smcc.com.ausporting@smcc.com.au

Ph. 0439389497

* Telephone: Home ( ) ______________________ Work ( )

SENIOR JUNIOR FAMILY ASSOCIATE

* Address (for newsletter) ___________________________________________________________________________

Section 1: MEMBER DETAILS

Rider 2: _____________________ Age: ________ Rider 3: _____________________ Age: __________

Please complete and attach indemnity form. See over . . . . .

*Note: Family membership consists of 1 or 2 parents and nominated children under 16 yrs.

Receipt #

FAMILY $75 JUN. / SEN. $50 DUAL $40 (if existing GMCC member) ASSOCIATE $40

Nomination for Membership Form

It is strongly recommended that all riders have personal accident insurance!

* Denotes mandatory field

* Occupation or skills: _________________________________________

In joining the SMCC I agree to help out at a min. of two club events per year

Sporting Motor Cycle Club Est.1932

* SENIOR RIDERS First name: __________________ Surname: _______________________

*NOTE: Memberships run for 12 months from date of approval. Allow 30 days for notification of approval. .xxI, _ Y_ O_ U_R_ _N_A _M_ E_ _ H _E _R _E hereby nominate for membership of the SPORTING MOTOR CYCLE CLUB,xxand agree to abide by all club rules and conditions of membership.

_______________________________________

Is S.M.C.C. your home / primary club? YES NO If not, name of your home club ____________________

EFT payments to: Sporting Motor Cycle Club Inc. BSB 633000 Acc. 115414872 Enter your surname for our reference

_______________________

* Mobile: ____________________________

____________________________* AMBULANCE COVER ( MEMBER NUMBER)