Membership Form

Title

First name:

Surname:

Occupation:

Date of birth:

Residential address:

Postal address (leave blank if same as above):

Telephone (business):

Telephone (mobile):

Telephone (home):

Fax:

Email address:

Are you licensed by any racing authority?

If yes, please give details:

Today's date:

Membership is $30. Upon submitting this form, we will contact you to confirm and arrange payment.

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