Membership Application Step 1 of 7 14% Are you an existing member?* Yes No Current Membership Number* Membership Type* Existing Membership (Single) - $75 Existing Membership (Family) - $90 Family Membership - 2 Adults & 3 Children (below 18 years of age)Membership Type* Single Membership - $75 Family Membership - $90 Family 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* 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* 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* 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* 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* DD slash MM slash YYYY Gender*MaleFemale Payment DetailsPayment Type* Direct Deposit Secure Credit Card (online) Direct Deposit detailsBSB: 012-430 Acct #: 231535272 Name: Southern Sporting Car Club Inc Reference: First & LastnameHiddenTotal $ 0.00 Credit Card American ExpressMasterCardVisaSupported Credit Cards: American Express, MasterCard, Visa Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name
