MEMBERSHIPApplication for MembershipApplication for membership of The “Falcon G.T. Club of Geelong Inc”Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastResidential Address *Postal Address (if different)DOBOccupationMobile *PhoneEmail *Spouse/Partner NameFirstLastEmailMobileMembership Type *FullFullAssociatedesire to become a FULL / ASSOCIATE member of The "Falcon G.T. Club of Geelong Inc”. (FULL – Owner of a Genuine Falcon GT)Vehicle Details1st Nomination Member Name:1st Nomination Member No.1st Nomination Member Signature1st Nomination Member Date2nd Nomination (President/Committee Member):2nd Nomination Member No.2nd Nomination Member Signature2nd Nomination Member DateMake & Model#1 Vehicle DetailsYearBody TypeConvertibleConvertibleCoupeFastbackSedanSUVUteVanWagonColourClub PermitYesYesNoRego or Permit No.VIN NumberMake & Model#2 Vehicle DetailsYearBody TypeConvertibleConvertibleCoupeHatchSedanSUVUteVanWagonColourClub PermitYesYesNoRego or Permit No.VIN NumberMake & Model#3 Vehicle DetailsYearBody TypeConvertibleConvertibleCoupeHatchSedanSUVUteVanWagonColourClub PermitYesYesNoRego or Permit No.VIN NumberMake & Model#4 Vehicle DetailsYearBody TypeConvertibleConvertibleCoupeHatchSedanSUVUteVanWagonColourClub PermitYesYesNoRego or Permit No.VIN NumberMake & Model#5 Vehicle DetailsYearBody TypeConvertibleConvertibleCoupeHatchSedanSUVUteVanWagonColourClub PermitYesYesNoRego or Permit No.VIN NumberApplication Date *Sign *Acknowledge and SignBy Signing, the applicant declares that: • The information in this form is true, correct and complete. • The applicant agrees to follow the Club Rules (a copy of the Club Rules will be made available on request). • The applicant takes full responsibility for any loss, damage or claim caused by any false statement made in this form, and the applicant indemnifies the Falcon GT Club Geelong (Inc), in respect of any loss, damage or claim.Submit
