Membership ALBANY 4WD CLUB INDIVIDUAL/FAMILY MEMBERSHIP FORM Surname: Given Name: Additional Family Names: Address: Email: Do you have any medical conditions the club needs to be aware of? Phone: Mobile: Primary Vehicle Make / Model: Rego: Secondary Vehicle Make / Model: Rego: Name of club member supporting this application: All membership applications are subject to 2 runs prior to approval of membership. Trip 1: Trip 2: Club Membership Fees: Family $75.00 | Individual $60.00 Disclaimer: The personal safety of any member or visitor, or that of their vehicle or equipment, shall be the sole responsibility of that person. The Club, its officers or any of its members shall accept no legal responsibility whatsoever for the safety of any other member or visitor of the Club present on or taking part in any activity of the club, regardless of the cause of any damage, accident or injury. All advice is given in good faith and no responsibility is taken. Acknowledgements: I / we acknowledge that we hold a current drivers licence and our vehicle is roadworthy & registered. I / we acknowledge that it is our responsibility to read and abide by the Club’s Constitution and By-Laws. Personal information collected on this form is used solely for club purposes. Applicants Signature: Date:
