Print Application form here - Royal Automobile Club of Australia

ROYAL AUTOMOBILE CLUB OF AUSTRALIA
Incorporating Imperial Service Club Limited
APPLICATION FOR MEMBERSHIP
Please circle: Mr / Mrs / Ms / Miss / Dr / Other :___________________________________________________
Given Names:_________________________________________________ Surname:_____________________________________
Please tick: □ Male □ Female
Residential Address:__________________________________________________________________________________________
____________________________________________________________________________Post Code:______________________
PO Box Address: _____________________________________________________________________________________________
____________________________________________________________________________Post Code:______________________
Company Name / Employer:_________________________________________________________________________________
Business Address:_____________________________________________________________________________________________
Defence Association/ Service Number:_______________________________________Post Code:______________________
Home Telephone: ( ) _______________ Mobile: _______________ Bus: ( ) _______________ Fax: ( ) _________________
Date of Birth: _______________Occupation:___________________ Email: ___________________________________________
Name of Proposer:________________________________ Signature:_________________________ M/ship No:_____________
Name of Seconder: ______________________________ Signature:__________________________ M/ship No: ____________
*If you do not have a RACA Member to propose and second your application for membership, please provide the Club with two referees.
Please complete the reverse side of this form as well showing referees.
MEMBERSHIP CATEGORY IS BASED ON YOUR RESIDENTIAL ADDRESS:
Tick Category Joining Fee Prepaid Spend Annual Subscription Total
Town (Sydney Residents) $250 $500 $1100 $1850
Country (NSW Country & ACT) $250 $500 $740 $1490
Corporate (At least 5 Members) N/A $500 $780 $1280
Young Executive (18-29 years) N/A $500 $715 $1215
Defence (Active/Reserves/Retired) N/A $500 $550 $1050
Interstate and Overseas $250 N/A $740 $990
Associate (Partner of Member) N/A N/A $550 $550
* Please supply one application per person applying for Membership.
* Please provide payment details on or with your application for Membership.
* The financial year of the Royal Automobile Club of Australia, commences on the 1st July 2012 and the above rates are valid to 30th June 2013.
* Applications for Membership are required to be paid in full and include applicable Joining Fee, the Prepaid Minimum Spend and Annual
Subscription Fee.
* Based on the month of your Application, Prepaid Minimum Spend and Annual Subscription rates are pro-rata.
* Prepaid Minimum Spend once paid is credited to your House Account upon submission and used at the Members discretion by the end of
each financial year.
* Members wishing to make use of our Health Club are required to complete our Club Fitness Assessment in accordance with our
policy and Fitness NSW criteria.
Enclosed is my cheque for $_______________________ or please debit my credit card of $_________________________
Please charge my: □ Visa □ MasterCard □ AMEX
Card Number: ____________________________________________________________________ Expiry Date: _______/_______
I certify that the above particulars are correct and hereby apply to be admitted for the Membership of the Royal
Automobile Club of Australia, if elected, I agree to be bound by its Constitution, Rules and By-Laws.
Signature of Applicant: ____________________________________________________________________ Date:_________________________
Please submit this Application form to Lisa Harris, Membership and Marketing Manager either in person, email, fax.or post.
My contact details are Telephone: 02 8273 2318, Email: lisa@raca.com.au or Fax: 02 8273 2388
89 Macquarie Street, Sydney NSW 2000 Australia * PO Box R1903 Royal Exchange, Sydney NSW 2000

ROYAL AUTOMOBILE
CLUB OF AUSTRALIA
ROYAL AUTOMOBILE CLUB OF AUSTRALIA
incorporating Imperial Service Club Limited
DIRECT: 02 8273 2318 ■ FAX: 02 8273 2388 ■ lisa@raca.com.au ■ www.raca.com.au
89 Macquarie Street, Sydney NSW 2000 Australia ■ PO Box R1903 Royal Exchange, Sydney NSW 2000
MEMBERSHIP applicants without proposer/seconder
NAME OF CANDIDATE:_ __________________________________________________________________________________________________
Telephone Bus:________________________ A/H_ ___________________________ Mobile:___________________________________________
Profession:_ ______________________________________________________________________________________________________________
Employer:________________________________________________________________________________________________________________
Position: _______________________________________________________Tenure:_ __________________________________________________
Previous Employer:________________________________________________________________________________________________________
Position: _______________________________________________________Tenure:_ __________________________________________________
Professional Referees (2)
Name :_ _____________________________________________________
Company:___________________________________________________
Position:_____________________________________________________
Telephone:___________________________________________________
Mobile:______________________________________________________
Notes: (Office use only)________________________________________
____________________________________________________________
Name:____________________________________________________
Company:_________________________________________________
Position:__________________________________________________
Telephone:________________________________________________
Mobile:___________________________________________________
Notes: (Office use only)______________________________________
_________________________________________________________
Please briefly explain why you wish to join the Royal Automobile Club of Australia:
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
I confirm that the above details are true and correct and, upon membership being conferred, I shall endeavour to maintain and uphold the
Club’s By-Laws required under the terms of membership.
Signed:________________________________________________________Date:____________________________________________________
CEO Referees
1. Y N Date:_____________________________________Outcome: ________________________________________________
2. Y N Date:_____________________________________Outcome: ________________________________________________
Membership Recommendation Y N Date:_ ___________
Date Submitted to Board:___________________________________________________________________________________________________