VICTORIAN CLUB MEMBERSHIP APPLICATION FORM
Please print out form, fill in and post to address shown below:  

NAME: FIRST

ADRESS:
Street
City/Suburb

State

Post/Zip Code

Country (If outside Australia)

Date of Application:



SURNAME

TELEPHONE:
(home)
(fax)
(business)
(mobile)
email

Previous Owners

PLEASE NOTE: THIS IS FOR

MODEL OF BOLWELL(s):
mk 1V
mk V
mk V1
mkV11
Nagari
Ikara

VEHICLE ORIGIN:
Coupe Sports
Factory Fibrecar Replica

Registration No:
Serial or Chassis No:
Colour:
SPECIFICATIONS:
Chassis type:
Engine:
Gearbox: Differential:
Brakes: Wheels:
Other details:

CONDITION:
Going
Static Minor repairs
Major repairs

OTHER VEHICLES IN YOUR GARAGE:


 


 



 





VICTORIA MEMBERSHIP ONLY
TYPE OF MEMBERSHIP:
Full year subscription (from 30th June each year) - $50.00
Second Half of year subscription - $30.00
Interstate membership - $35.00
Mould share - $200.00
Interested
in recieving Slipstream by email Y/N

New members only -
Introducted to BCCA(VIC) by________________________
Your cheques should be made out to The Bolwell Car Club of Victoria Inc.:
Your membership will be activated once your payment has
been received. The postal address is:
THE SECRETARY BOLWELL CAR CLUB OF AUSTRALIA(VIC) INC.
PO Box 1009
RINGWOOD Vic. 3134
AUSTRALIA

 

 

Office use only:  
Date Joined: Membership No:
Amount Paid: Receipt No:
Period: Share No: (If purchased):

 

 

 

 

 

 

 

 

 


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