Membership Application Step 1 of 7 14% Are you an existing member?*YesNoCurrent Membership Number*Membership Type*Single Membership - $75Family Membership - $90Family Membership - 2 Adults & 3 Children (below 18 years of age)Adults*12Children*0123 Primary Member DetailsName First Last Address* Street Address Address Line 2 Suburb State Post Code Mobile*HomeEmail* Date of Birth* Date Format: DD slash MM slash YYYY Gender*MaleFemaleClub Magazine Electronically by Email Hard copy by Australia Post 2nd Adult - Member DetailsName* First Last Click here if address details are different Address* Street Address Address Line 2 Suburb State Post Code Mobile*Home PhoneEmail Club Magazine Electronic by Email Date of Birth* Date Format: DD slash MM slash YYYY Gender*MaleFemale 1st Child - Member DetailsName First Last Click here if address details are different Address* Street Address Address Line 2 Suburb State Post Code MobileHomeEmail Club Magazine Electronic by Email Date of Birth* Date Format: DD slash MM slash YYYY Gender*MaleFemale 2nd Child - Member DetailsName First Last Click here if address details are different Address* Street Address Address Line 2 Suburb State Post Code MobileHomeEmail Club Magazine Electronic by Email Date of Birth* Date Format: DD slash MM slash YYYY Gender*MaleFemale 3rd Child - Member DetailsName First Last Click here if address details are different Address* Street Address Address Line 2 Suburb State Post Code MobileHomeEmail Club Magazine Electronic by Email Date of Birth* Date Format: DD slash MM slash YYYY Gender*MaleFemale Payment DetailsPayment Type*Direct DepositSecure Credit Card (online)Direct Deposit detailsBSB: 012-430 Acct #: 231535272 Name: Southern Sporting Car Club Inc Reference: First & LastnameTotal $ 0.00 Credit Card American ExpressMasterCardVisa Card Number Month010203040506070809101112 Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 Expiration Date Security Code Cardholder Name
