MOTO GUZZI CLUB OF QUEENSLAND INC

PO Box 1159
Fortitude Valley QLD 4006

www.motoguzziclubqld.org
info@motoguzziclubqld.org

2008 MEMBERSHIP APPLICATION  


NAME         Surname: _________________________________________


          Given Name: _________________________________________ 

	
MAIL ADDRESS   Email: _________________________________________


     Street / PO Box: _________________________________________


   Suburb & Postcode: _________________________________________
	

PHONE NUMBERS   Home: _________________________________________


	        Work: _________________________________________


	      Mobile: _________________________________________


BIKE    Make & Model: _________________________________________

DECLARATION

By submitting this membership application form, I hereby agree to abide 
by the rules and regulations of the Moto Guzzi Club of Queensland Inc. 

MEMBERSHIP FEE *        [ ]  New Member ($30)  
                                        (includes 1st year’s membership)
	                [ ]  Membership Renewal ($20) 
                      

    Signature & Date: __________________________ Date:________
Please forward the completed form, with the appropriate membership fee, 
to the Moto Guzzi Club of Queensland.

* An Associate Member is a member who does not own a motorbike.