Name..............................................................................................Member No: .......................
Address...........................................................................................................................................
...........................................................................................................................................................
Telephone.......................................................................................................................................
E-mail..............................................................................................................................................
Club Permit Vehicle Register
Permit No.
Make & Model.
Expires.
...........................................................................................................................................................
...........................................................................................................................................................
...........................................................................................................................................................
Other Bikes Owned:.....................................................................................................................
Motorcycling
Interests: (Please indicate) Touring
Social
Off-Road
Restoration
Competition
Other.......................................................................................................
Membership Fees:
Membership
Victoria
Other
States
International
Single
$40.00
$30.00
$AUD40.00
Family
$50.00
$37.50
$AUD50.00
Payment enclosed:..................................
Card No: __|__| __|
__| __|__| __| __| __|__| __|
__| __|__| __| __|
Expiry Date
Type:
Visa
Master Bankcard
Signature……………………………………………………….Date__|__|
__| __|
BSA Motorcycle Owners Assoc’n Inc, P.O.
Box 2400, Oakleigh,
Vic, 3166. |