JDCC - Membership Application / Renewal Form 2017 / 2018

I hereby apply to be a member/renew my membership of the Jaguar Drivers' Club of
Canberra Inc. and agree to abide by the rules of the Club.

   Applicant's Surname      Initials 

     Preferred Given Name  

   Partner's Surname (Optional)      Initials 

     Preferred Given Name  

   Address details For Correspondence   

      City/Town         State     Postcode 

   Residential Address (if different)         

     City/Town          State     Postcode  

     Telephone (H)     (W)     Mobile 

     Email      Current Member No. 

CAR INFORMATION

   Model     Body Style    Colour 

     Year    Engine Capacity    Rego No. 

   Model     Body Style    Colour 

     Year    Engine Capacity    Rego No. 

FEES  The membership year is a financial year (from July to June).

Membership (includes dependents) $70 pa  
     Half year (if joining after December, new memebers only)    $35  
     Quarter year (if joining after March, new members only)    $20  
Signed Date       /      / $

To submit your membership application / renewal please complete this form, print, sign and
date it and forward it to:

Jaguar Drivers' Club of Canberra Inc. PO Box 4400. KINGSTON ACT 2604

Then EITHER:

Include a cheque for payment of fees made out to : Jaguar Drivers' Club of Canberra Inc.

OR

Make a direct payment for the fee amount to the club's bank account:
Jaguar Drivers' Club of Canberra, Account no: 03413088, BSB no: 805-022
using your surname and/or membership number as a reference to enable reconciliation of your payment.