Membership

To join or renew your membership of the Fiat Car Club of Western Australia, please print out this page, complete, and post with appropriate (Australian) dollars to the address at the bottom.

1999 Membership fee is $35.00 for full membership and $15.00 for associates

Name_________________________________________________Date of Birth__________

Address____________________________________________________Postcode________

Nominated Club Car - Make and Model______________________________Year________

Engine Size_______________cc Colour_____________________Rego No.____________

Other Cars - Make and Model______________________________Year_______________

Engine Size_______________cc Colour_____________________Rego No.____________

Make and Model____________________________________________Year_____________

Engine Size_______________cc Colour_____________________Rego No.______________

Member Signature______________________________________Date________/_______/_________

Associate Signature_____________________________________Date________/_______/_________

Office Use Only

Date_________________Amount______________Member No.____________

FIAT CAR CLUB WA, P.O. BOX 137, TUART HILL WA 6060, AUSTRALIA

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