Membership

Become a member of the Queensland Chevrolet Car Club Inc.

Membership-Form-5-Jan-2017

First Name (required)

Last Name (required)

Phone Number (required)

Address (required)

Email (required)

Is this a new membership or Renewal Membership?
 New Renewal

Are you a member of ASMF or ASRF.
 Yes No

If yes, your member number

Do you currently have limited club rego?
 Yes No

If yes, is it through this club?
 Yes No

If not, Club registration number if on limited rego

Registration Number if on limited rego

Please list your Chevrolet vehicle/s

* After you have submitted your application, please Direct Deposit $40 to:
BSB 484799
A/C# 012084441