Memebrship Application Form, New Members Only
Membership Type *
To compete in Events an appropriate Licence must be held.
The Club Championship & Financial year is 1 May to 30 April.
Name *
Address *
Date of Birth *
Home Phone *
Mobile Phone *
Email
Occupation
Reason for Joining *
If elected to membership I agree to abide by the Southland Sports Car Club Inc. Rules and duly authorise the Southland Sports Car Club Inc. to provide information concerning my membership to Motorsport New Zealand Inc. if requested by them. *
Date *
Please type the letters and numbers shown in the image.
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 Total: $