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Membership Registration

Date of birth:
Day
Month
Year
Multi choice

Declaration: 

I declare that the information I have provided on this application form is true, accurate and complete to  the best of my knowledge and there are no other factors that I am aware of which may affect this  application in any way. I agree to abide by the rules of the Sapphire Coast Sporting Car Club Inc.


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Date
Day
Month
Year
Membership Fees:

Deposit into club IMB account below


BSB - 641800

Account Number - 200709738

When depositing Membership fees, put your full name and membership(s)

purchased in the description

Payment method
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