Membership Form

Application For Membership.

P.O. Box 2847

Carlingford Court

N.S.W.2118

First Name…………………………. Surname …………………………………

Street……………………………….. Town / City………………………………

State…………..Postcode…………..Tel: ………………….. Fax:………………

Mobile……………………. .................

Date Of Birth (Month Only).................................................

Email Address............................................................................

Membership Type: Full / Associate / Junior / Please Delete Non Applicable

New membership fees are $45.00.

Renewals are $40.00 per year.

Fees are due at the end of June each year.

Car Details:

Year ……………..Model…………………… Body Type………………

Exterior Colour………………..Interior Colour ……………………..

Chassis No………………Engine No……………… Body No…………………

Engine Capacity………..cc No. of Cylinders………. Iron Or Alloy Head? CI / Alloy.

Gearbox Type. Manual, Overdrive, Automatic . …………………………

Car Original Condition Or Restored ………………………..

Original Rego No. If Known ………………….

Subsequent Registrations: 2. …………..3. …………….4 ……………..

Any Unusual Features Or Additions …………………………………..

…………………………………………………………………………….

……………………………………………………………………………..

Do You Own Any Other Hillmans? Please Give Details ………………..

……………………………………………………………………………….

Are You A Member Of Another Car Club? And Do You Nominate This Club

As Your Primary Or Secondary Club? Primary. Secondary.

Other Clubs.

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In making this application for membership of the Hillman Owners Club Of Australia Inc, I hereby agree to abide by all the rules and regulations of the said club. Further, I understand that should any fees payable by me to the club fall more than three months in arrears without satisfactory explanation, then the club may consider my membership as being resigned.

Signature of Applicant………………………… Date………………………

Proposed by …………………………

Signature …………………………

Seconded by ………………………….

Signature ………………………….

Fees Paid $………………. Date Paid ………………..

Membership No: …………. Join Date ………………

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The Hillman Owners Club of Australia Inc.